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General NPI Number Information
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NPI Number | 1881036713
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Entity Type | Organization
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Legal Business Name | CLINTON HMPN, LLC
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Dates
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Enumeration Date | 07/19/2013
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Last Update Date | 07/19/2013
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Provider Practice Location Address
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Address Line | 341 S 28TH ST
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City | CLINTON
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State | OK
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Zip | 73601-3701
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Country | US
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Telephone | 580-323-8747
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Fax | 580-323-8426
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Provider Business Mailing Address
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Address Line | 5811 PELICAN BAY BLVD #500
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City | NAPLES
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State | FL
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Zip | 34108-2733
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Country | US
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Telephone | 239-552-3575
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Fax | 239-552-3575
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONALD PATRICK EASTERLING
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Credential |
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Telephone | 239-552-3575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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