Provider Demographics
NPI:1487745238
Name:FAMILY MEDICINE OF MIDWEST CITY, LLC
Entity type:Organization
Organization Name:FAMILY MEDICINE OF MIDWEST CITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-733-5800
Mailing Address - Street 1:9065 HARMONY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5239
Mailing Address - Country:US
Mailing Address - Phone:405-733-5800
Mailing Address - Fax:405-733-5913
Practice Address - Street 1:9065 HARMONY DRIVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5239
Practice Address - Country:US
Practice Address - Phone:405-733-5800
Practice Address - Fax:405-733-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty