Provider Demographics
NPI:1205285988
Name:ABC MEDICAL CLINIC OF HOLDENVILLE, LLC
Entity type:Organization
Organization Name:ABC MEDICAL CLINIC OF HOLDENVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-927-2334
Mailing Address - Street 1:1011 N HINCKLEY ST
Mailing Address - Street 2:
Mailing Address - City:HOLDENVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74848-3846
Mailing Address - Country:US
Mailing Address - Phone:405-592-3500
Mailing Address - Fax:
Practice Address - Street 1:1011 N HINCKLEY ST
Practice Address - Street 2:
Practice Address - City:HOLDENVILLE
Practice Address - State:OK
Practice Address - Zip Code:74848-3846
Practice Address - Country:US
Practice Address - Phone:405-592-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health