Healthcare Provider Details

I. General information

NPI: 1114414760
Provider Name (Legal Business Name): SEMINOLE HMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2249 BOREN BLVD
SEMINOLE OK
74868-1927
US

IV. Provider business mailing address

2249 BOREN BLVD
SEMINOLE OK
74868-1927
US

V. Phone/Fax

Practice location:
  • Phone: 405-382-6932
  • Fax: 405-382-6028
Mailing address:
  • Phone: 405-382-6932
  • Fax: 405-382-6028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number2342
License Number StateOK

VIII. Authorized Official

Name: PAULA LALOR
Title or Position: DIRECTOR
Credential:
Phone: 629-215-3953