| |
1201 E Jackson St Hugo OK 74743-4229 | |
(580) 326-6423 | |
(580) 326-3660 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1201 E Jackson St, Hugo, Oklahoma |
Authorized Official Name and Position | Victoria Elaine Pardue (MEDICAL DIRECTOR PARTNER) |
Authorized Official Contact | 5803266423 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1201 E Jackson St Hugo OK 74743-4229 Ph: (580) 326-6423 | 1201 E Jackson St Hugo OK 74743-4229 Ph: (580) 326-6423 |
NPI Number | 1831313568 |
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Provider Enumeration Date | 04/12/2007 |
Last Update Date | 01/12/2015 |
Medicare PECOS PAC ID | 2466486329 |
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Medicare Enrollment ID | O20050921000338 |
Identifier | Type | State | Issuer |
---|---|---|---|
1831313568 | NPI | - | NPPES |
100730820C | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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