Provider Demographics
NPI:1457793093
Name:BLACKWELL HMPN, LLC
Entity Type:Organization
Organization Name:BLACKWELL HMPN, LLC
Other - Org Name:TONKAWA MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-552-3575
Mailing Address - Street 1:5811 PELICAN BAY BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2711
Mailing Address - Country:US
Mailing Address - Phone:239-552-3131
Mailing Address - Fax:
Practice Address - Street 1:600 E GRAND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TONKAWA
Practice Address - State:OK
Practice Address - Zip Code:74653-3558
Practice Address - Country:US
Practice Address - Phone:580-628-2138
Practice Address - Fax:580-628-2293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH MANAGEMENT ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-24
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty