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General NPI Number Information
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NPI Number | 1922439421
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Entity Type | Organization
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Legal Business Name | GREG CLEMENT AGENCY
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 509 N 1ST ST
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City | MADILL
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State | OK
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Zip | 73446-1406
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Country | US
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Telephone | 580-795-3064
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 846
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City | MADILL
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State | OK
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Zip | 73446
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Country | US
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Telephone | 580-795-3064
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Fax |
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Authorized Official
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Title or Position | OWNEER/AGENT
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Name | GREGORY L CLEMENT
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Credential |
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Telephone | 580-795-3064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 7598553
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License Number State | OK
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