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General NPI Number Information
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NPI Number | 1659372712
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Entity Type | Organization
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Legal Business Name | MARSHALL COUNTY HMA LLC
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 06/12/2013
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Provider Practice Location Address
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Address Line | 700 E. HIGHWAY 70
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City | KINGSTON
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State | OK
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Zip | 73439
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Country | US
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Telephone | 580-564-4944
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Fax | 580-564-4344
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Provider Business Mailing Address
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Address Line | PO BOX 762
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City | KINGSTON
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State | OK
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Zip | 73439-0762
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Country | US
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Telephone | 580-564-4944
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | STEVEN E CLIFTON
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Credential |
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Telephone | 239-598-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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