1841720877 NPI number — CLINTON HMA LLC

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 1841720877 NPI number — CLINTON HMA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINTON HMA LLC
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:
ALLIANCEHEALTH CLINIC THOMAS
Provider Other Organization Name Type Code:
3
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:
1841720877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 689022
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37068-9022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
615-628-6877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 S 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THOMAS
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73669-8201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-323-2363
Provider Business Practice Location Address Fax Number:
580-331-1484
Provider Enumeration Date:
06/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SWAW
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
615-778-8076

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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