Provider Demographics
NPI:1548762982
Name:HILBURN, LLOYD DEAN
Entity Type:Individual
Prefix:MR
First Name:LLOYD
Middle Name:DEAN
Last Name:HILBURN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N. BROADWAY
Mailing Address - Street 2:P.O. BOX 99
Mailing Address - City:CARNEGIE
Mailing Address - State:OK
Mailing Address - Zip Code:73015
Mailing Address - Country:US
Mailing Address - Phone:580-654-1439
Mailing Address - Fax:580-654-2637
Practice Address - Street 1:225 N. BROADWAY
Practice Address - Street 2:P.O. BOX 99
Practice Address - City:CARNEGIE
Practice Address - State:OK
Practice Address - Zip Code:73015
Practice Address - Country:US
Practice Address - Phone:580-654-1439
Practice Address - Fax:580-654-2637
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1195376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100774209370E24Medicaid