Healthcare Provider Details

I. General information

NPI: 1659372712
Provider Name (Legal Business Name): MARSHALL COUNTY HMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E. HIGHWAY 70
KINGSTON OK
73439
US

IV. Provider business mailing address

PO BOX 762
KINGSTON OK
73439-0762
US

V. Phone/Fax

Practice location:
  • Phone: 580-564-4944
  • Fax: 580-564-4344
Mailing address:
  • Phone: 580-564-4944
  • Fax:

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: STEVEN E CLIFTON
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 239-598-3131