Provider Demographics
NPI:1811359607
Name:HEALTHCARE STAT OF ANADARKO INC
Entity type:Organization
Organization Name:HEALTHCARE STAT OF ANADARKO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:405-822-2761
Mailing Address - Street 1:PO BOX 5908
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-5908
Mailing Address - Country:US
Mailing Address - Phone:405-247-1100
Mailing Address - Fax:405-247-1155
Practice Address - Street 1:1503 S MISSION ST
Practice Address - Street 2:SUITE A
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-5815
Practice Address - Country:US
Practice Address - Phone:405-247-1100
Practice Address - Fax:405-247-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3253207P00000X
OK97727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty