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WINDSOR PARK MEDICAL CLINIC
NPI 1104070259
Physician Assistant in Oklahoma City, OK

Active since November 14, 2008CLIA 37D1027083 · Waiver
2512 N MERIDIAN AVE, OKLAHOMA CITY, OK 73107(405) 605-5415(405) 605-5310 Get Directions Write a Review

NPPES record last updated: November 14, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Windsor Park Medical Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WINDSOR PARK MEDICAL CLINIC (NPI 1104070259) is a healthcare organization registered as a physician assistant in Oklahoma City, Oklahoma and active in the NPI registry since November 2008. The organization holds a CLIA Waiver certificate valid through October 30, 2027 and lists Stacy Louise Fagan, Physician Assistant, as its authorized official.

NPPES Registry Identity

NPI1104070259
Entity TypeOrganization
Primary Taxonomy363A00000X
Legal Business NameWINDSOR PARK MEDICAL CLINIC
Location Address2512 N MERIDIAN AVEOklahoma City, OK 73107-1035
Mailing Address2512 N Meridian AveOklahoma City, OK 73107-1035 · (405) 605-5415 · Fax (405) 605-5310
Phone(405) 605-5415
Fax(405) 605-5310
Organization SubpartNo
Authorized OfficialStacy Louise FaganPhysician Assistant · (405) 605-5415
Enumeration DateNovember 14, 2008
✔ NPI 1104070259 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in OK · 1779
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
2512 N MERIDIAN AVE, Oklahoma City, OK 73107
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 37D1027083

Windsor Park Medical Clinic, LLC · Oklahoma City, OK
Active · expires Oct 30, 2027
CLIA Number37D1027083
Laboratory TypePhysician Office
Certificate Effective DateOctober 31, 2025
Certificate Expiration DateOctober 30, 2027
Laboratory DirectorAlex Dwuma
Laboratory Phone(405) 605-5415
Laboratory LocationWindsor Park Medical Clinic, LLC2512 N Meridian St, Oklahoma City, OK 73107
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. STACY LOUISE FAGAN P.A.
Physician Assistant (Medical)
2512 N MERIDIAN AVE
OKLAHOMA CITY, OK 73107
Oklahoma County (405) 605-5415
JILL WHITNEY FROST PA-C
Physician Assistant
2512 N MERIDIAN AVE
OKLAHOMA CITY, OK 73107
Oklahoma County (405) 605-5415

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Windsor Park Medical Clinic's NPI number?

The NPI number for Windsor Park Medical Clinic is 1104070259. It was assigned to this organization in the NPPES registry on November 14, 2008.

Where is Windsor Park Medical Clinic located?

Windsor Park Medical Clinic is located at 2512 N Meridian Ave, Oklahoma City, OK 73107. The listed phone number is (405) 605-5415.

What is Windsor Park Medical Clinic's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Does Windsor Park Medical Clinic hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 37D1027083) is associated with this NPI, valid through October 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Windsor Park Medical Clinic was last updated on November 14, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.