Provider Demographics
NPI:1891773727
Name:HEART AND MEDICAL CENTER INC
Entity Type:Organization
Organization Name:HEART AND MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:
Authorized Official - Last Name:KHETPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-931-0500
Mailing Address - Street 1:2701 W. UNIVERSITY BLVD.
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2997
Mailing Address - Country:US
Mailing Address - Phone:580-931-0500
Mailing Address - Fax:580-920-8027
Practice Address - Street 1:2701 W. UNIVERSITY BLVD.
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2997
Practice Address - Country:US
Practice Address - Phone:580-931-0500
Practice Address - Fax:580-920-8027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20426261QM2500X
TXK5131261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746940AMedicaid
OK600522043Medicare ID - Type UnspecifiedMDC GROUP
OKF74655Medicare UPIN