Provider Demographics
NPI:1083667075
Name:DURANT HMA INC.
Entity Type:Organization
Organization Name:DURANT HMA INC.
Other - Org Name:JAISWAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-598-3051
Mailing Address - Street 1:PO BOX 995
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74702-0995
Mailing Address - Country:US
Mailing Address - Phone:580-924-4704
Mailing Address - Fax:580-924-6001
Practice Address - Street 1:702 BRYAN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-7000
Practice Address - Country:US
Practice Address - Phone:580-924-4704
Practice Address - Fax:580-924-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty