Provider Demographics
NPI:1508032756
Name:LATIMER COUNTY HEALTH CLINIC
Entity Type:Organization
Organization Name:LATIMER COUNTY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-465-5716
Mailing Address - Street 1:806 HIGHWAY 2 N
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-3625
Mailing Address - Country:US
Mailing Address - Phone:918-465-5716
Mailing Address - Fax:918-465-9931
Practice Address - Street 1:806 HIGHWAY 2 N
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-3625
Practice Address - Country:US
Practice Address - Phone:918-465-5716
Practice Address - Fax:918-465-9931
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LATIMER COUNTY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty