Provider Demographics
NPI:1114414760
Name:SEMINOLE HMA LLC
Entity Type:Organization
Organization Name:SEMINOLE HMA LLC
Other - Org Name:ALLIANCEHEALTH SEMINOLE CLINIC BOREN BLVD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:2249 BOREN BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-1927
Mailing Address - Country:US
Mailing Address - Phone:405-382-6932
Mailing Address - Fax:405-382-6028
Practice Address - Street 1:2249 BOREN BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-1927
Practice Address - Country:US
Practice Address - Phone:405-382-6932
Practice Address - Fax:405-382-6028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2342261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health