Healthcare Provider Details

I. General information

NPI: 1730606518
Provider Name (Legal Business Name): HOCHATOWN MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6613 N US HIGHWAY 259
BROKEN BOW OK
74728-6591
US

IV. Provider business mailing address

6966 S UTICA AVE STE 225
TULSA OK
74136-3903
US

V. Phone/Fax

Practice location:
  • Phone: 918-689-2500
  • Fax:
Mailing address:
  • Phone: 918-492-6333
  • Fax: 918-493-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC HOGAN
Title or Position: OWNER
Credential: DO
Phone: 918-689-2500