Provider Demographics
NPI:1033308267
Name:FRANK L HUBBARD INC
Entity Type:Organization
Organization Name:FRANK L HUBBARD INC
Other - Org Name:CIMARRON MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SNAVELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-225-6904
Mailing Address - Street 1:PO BOX 1707
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-1707
Mailing Address - Country:US
Mailing Address - Phone:918-225-6904
Mailing Address - Fax:918-225-4559
Practice Address - Street 1:2340 E MAIN ST
Practice Address - Street 2:ST 1
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-2905
Practice Address - Country:US
Practice Address - Phone:918-225-6904
Practice Address - Fax:918-225-4559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANK L HUBBARD DO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-24
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty