Healthcare Provider Details

I. General information

NPI: 1548762982
Provider Name (Legal Business Name): MR. LLOYD DEAN HILBURN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N. BROADWAY P.O. BOX 99
CARNEGIE OK
73015
US

IV. Provider business mailing address

225 N. BROADWAY P.O. BOX 99
CARNEGIE OK
73015
US

V. Phone/Fax

Practice location:
  • Phone: 580-654-1439
  • Fax: 580-654-2637
Mailing address:
  • Phone: 580-654-1439
  • Fax: 580-654-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number1195
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: