Healthcare Provider Details

I. General information

NPI: 1972545820
Provider Name (Legal Business Name): RICHARD J HELTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W OHIO
COALGATE OK
74538-2827
US

IV. Provider business mailing address

PO BOX 345
COALGATE OK
74538-0345
US

V. Phone/Fax

Practice location:
  • Phone: 580-927-2334
  • Fax: 580-927-9941
Mailing address:
  • Phone: 580-927-2334
  • Fax: 580-927-9941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2096
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number2096
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: