Provider Demographics
NPI:1467993253
Name:SOUTHEAST OKLAHOMA MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:SOUTHEAST OKLAHOMA MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-927-2334
Mailing Address - Street 1:108 W OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:COALGATE
Mailing Address - State:OK
Mailing Address - Zip Code:74538-2827
Mailing Address - Country:US
Mailing Address - Phone:580-927-2334
Mailing Address - Fax:
Practice Address - Street 1:1308 E CARL ALBERT PKWY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5236
Practice Address - Country:US
Practice Address - Phone:580-927-2334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care