=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043277262
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OLTON CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 524 8TH STREET
-----------------------------------------------------
City | OLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79064-0674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 3
-----------------------------------------------------
Fax | 806-285-3312
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 524 8TH STREET
-----------------------------------------------------
City | OLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 3
-----------------------------------------------------
Fax | 806-285-3312
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMT -I
-----------------------------------------------------
Name | MS. DENISE A HASHA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 3
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 241316
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------