Provider Demographics
NPI:1073538666
Name:NEWKIRK RURAL HEALTH CLINIC
Entity Type:Organization
Organization Name:NEWKIRK RURAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-362-2555
Mailing Address - Street 1:601A W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:NEWKIRK
Mailing Address - State:OK
Mailing Address - Zip Code:74647-5525
Mailing Address - Country:US
Mailing Address - Phone:580-362-2555
Mailing Address - Fax:580-362-2091
Practice Address - Street 1:601A W SOUTH ST
Practice Address - Street 2:
Practice Address - City:NEWKIRK
Practice Address - State:OK
Practice Address - Zip Code:74647-5525
Practice Address - Country:US
Practice Address - Phone:580-362-2555
Practice Address - Fax:580-362-2091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK373864Medicare ID - Type UnspecifiedRURAL HEALTH NUMBER