Healthcare Provider Details

I. General information

NPI: 1487184412
Provider Name (Legal Business Name): CLINTON HMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S 9TH ST
CLINTON OK
73601-3328
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-2300
  • Fax: 580-323-8710
Mailing address:
  • Phone:
  • Fax: 615-628-6877

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: MICHAEL A SWAW
Title or Position: DIRECTOR
Credential:
Phone: 615-778-8076