Provider Demographics
NPI:1659597706
Name:SAM HIDER COMMUNITY CLINIC
Entity Type:Organization
Organization Name:SAM HIDER COMMUNITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:POSTIER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:918-253-4271
Mailing Address - Street 1:33396 S 550 RD
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346-5478
Mailing Address - Country:US
Mailing Address - Phone:918-787-6593
Mailing Address - Fax:
Practice Address - Street 1:1015 WASHBURN
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346
Practice Address - Country:US
Practice Address - Phone:918-253-4271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0068852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK8EC410OtherPROVIDER
S72172Medicare UPIN