Basic Information
| Provider Information | |||||||||
| NPI: | 1700063229 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RICHARD J HELTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 345 | ||||||||
| Address2: | |||||||||
| City: | COALGATE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 745380345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809272334 | ||||||||
| FaxNumber: | 5809279941 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 W OHIO AVE | ||||||||
| Address2: | |||||||||
| City: | COALGATE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 745382827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809272334 | ||||||||
| FaxNumber: | 5809279941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2008 | ||||||||
| LastUpdateDate: | 01/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | HELTON | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5809272334 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 373823 | 01 | OK | MEDICARE PART A | OTHER |