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General NPI Number Information
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NPI Number | 1215404108
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Entity Type | Organization
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Legal Business Name | THE HEART CLINIC, P.C.
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 3720 W BROADWAY ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-2141
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Country | US
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Telephone | 918-910-5301
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Fax | 918-910-5279
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Provider Business Mailing Address
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Address Line | 701 E DECATUR ST
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City | BROKEN ARROW
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State | OK
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Zip | 74011-3575
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Country | US
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Telephone | 918-348-9715
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAZEN HAMWY
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Credential | MD
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Telephone | 918-348-9715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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