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General NPI Number Information
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NPI Number | 1720033087
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Entity Type | Organization
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Legal Business Name | NEON CLINIC INC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1800 W UNIVERSITY BLVD
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City | DURANT
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State | OK
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Zip | 74701-3006
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Country | US
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Telephone | 580-924-3080
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 15268
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City | ASHEVILLE
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State | NC
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Zip | 28813-0268
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Country | US
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Telephone | 828-250-2835
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMY FORD
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Credential |
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Telephone | 903-640-7317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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