Basic Information
| Provider Information | |||||||||
| NPI: | 1679936488 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOLDENVILE CLINIC AND URGENT CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 345 | ||||||||
| Address2: | |||||||||
| City: | COALGATE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 745380345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809272334 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1011 N HINCKLEY ST | ||||||||
| Address2: | |||||||||
| City: | HOLDENVILLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748483846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809272334 | ||||||||
| FaxNumber: | 5809279941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2016 | ||||||||
| LastUpdateDate: | 03/30/2016 | ||||||||
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| AuthorizedOfficialLastName: | HELTON | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5809272334 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.