Provider Demographics
NPI:1831313568
Name:ROWLAND FLATT HUGO RURAL HEALTH CLINIC
Entity Type:Organization
Organization Name:ROWLAND FLATT HUGO RURAL HEALTH CLINIC
Other - Org Name:HUGO MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:PARDUE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-326-6423
Mailing Address - Street 1:1201 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-4229
Mailing Address - Country:US
Mailing Address - Phone:580-326-6423
Mailing Address - Fax:580-326-3660
Practice Address - Street 1:1201 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4229
Practice Address - Country:US
Practice Address - Phone:580-326-6423
Practice Address - Fax:580-326-3660
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROWLAND FLATT CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100730820CMedicaid
OK100730820CMedicaid