Provider Demographics
NPI:1235300575
Name:ROWLAND-ELLIS-FLATT HUGO RURAL HEALTH CLINIC
Entity Type:Organization
Organization Name:ROWLAND-ELLIS-FLATT HUGO RURAL HEALTH CLINIC
Other - Org Name:HUGO RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAIN, OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:PARDUE
Authorized Official - Suffix:
Authorized Official - Credentials:DO,
Authorized Official - Phone:580-326-6423
Mailing Address - Street 1:1201 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-4229
Mailing Address - Country:US
Mailing Address - Phone:580-326-6423
Mailing Address - Fax:580-326-3660
Practice Address - Street 1:1201 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4229
Practice Address - Country:US
Practice Address - Phone:580-326-6423
Practice Address - Fax:580-326-3660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROWLAND-ELLIS-FLATT CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-14
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100708140CMedicaid
OK0361410001Medicare NSC
PW373833Medicare PIN