Provider Demographics
NPI:1376226829
Name:IDABEL MEDICAL CLINIC, PLLC
Entity Type:Organization
Organization Name:IDABEL MEDICAL CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:NACOLE
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:580-612-7748
Mailing Address - Street 1:805 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-3331
Mailing Address - Country:US
Mailing Address - Phone:580-286-1095
Mailing Address - Fax:580-286-3122
Practice Address - Street 1:805 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-3331
Practice Address - Country:US
Practice Address - Phone:580-286-1095
Practice Address - Fax:580-286-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty