Healthcare Provider Details

I. General information

NPI: 1881036713
Provider Name (Legal Business Name): CLINTON HMPN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 S 28TH ST
CLINTON OK
73601-3701
US

IV. Provider business mailing address

5811 PELICAN BAY BLVD #500
NAPLES FL
34108-2733
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-8747
  • Fax: 580-323-8426
Mailing address:
  • Phone: 239-552-3575
  • Fax: 239-552-3575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DONALD PATRICK EASTERLING
Title or Position: PRESIDENT
Credential:
Phone: 239-552-3575