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General NPI Number Information
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NPI Number | 1790028496
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Entity Type | Organization
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Legal Business Name | THE MEDICAL CLINIC, INC
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 1630 SANTA FE ST.
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City | WAYNOKA
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State | OK
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Zip | 73860-0000
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Country | US
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Telephone | 580-824-0330
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Fax | 580-824-0939
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Provider Business Mailing Address
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Address Line | 1630 SANTA FE ST
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City | WAYNOKA
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State | OK
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Zip | 73860-0000
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Country | US
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Telephone | 580-824-0330
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Fax | 580-824-0939
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSAN M HULL
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Credential | M.D.
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Telephone | 580-824-0330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 28454
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License Number State | OK
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