Provider Demographics
NPI:1013072644
Name:KIMBERLY K HANIGAR
Entity Type:Organization
Organization Name:KIMBERLY K HANIGAR
Other - Org Name:MCLOUD FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HANIGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-964-6463
Mailing Address - Street 1:PO BOX 530
Mailing Address - Street 2:704 S 8TH STREET
Mailing Address - City:MCLOUD
Mailing Address - State:OK
Mailing Address - Zip Code:74851-0530
Mailing Address - Country:US
Mailing Address - Phone:405-964-6463
Mailing Address - Fax:405-964-2412
Practice Address - Street 1:704 S 8TH STREET
Practice Address - Street 2:
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851-0530
Practice Address - Country:US
Practice Address - Phone:405-964-6463
Practice Address - Fax:405-964-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100126130CMedicaid
233714201Medicare PIN