Provider Demographics
NPI:1447765086
Name:HEALTHCARE STAT OF LINDSAY LLC
Entity Type:Organization
Organization Name:HEALTHCARE STAT OF LINDSAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:405-659-5656
Mailing Address - Street 1:PO BOX 5908
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-5908
Mailing Address - Country:US
Mailing Address - Phone:405-659-5656
Mailing Address - Fax:405-701-5421
Practice Address - Street 1:301 E CHEROKEE ST STE F
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:OK
Practice Address - Zip Code:73052-4414
Practice Address - Country:US
Practice Address - Phone:405-659-5656
Practice Address - Fax:405-701-5421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty