1831313568 NPI number — ROWLAND FLATT HUGO RURAL HEALTH CLINIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831313568 NPI number — ROWLAND FLATT HUGO RURAL HEALTH CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROWLAND FLATT HUGO RURAL HEALTH CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HUGO MEDICAL CLINIC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831313568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 E JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUGO
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74743-4229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-326-6423
Provider Business Mailing Address Fax Number:
580-326-3660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 E JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUGO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74743-4229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-326-6423
Provider Business Practice Location Address Fax Number:
580-326-3660
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PARDUE
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
MEDICAL DIRECTOR PARTNER
Authorized Official Telephone Number:
580-326-6423

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100730820C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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