Organization Name: | IRVIN MEDICAL CLINIC |
NPI Number: | 1215320320 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL IRVIN (OWNER) |
Mailing Address: | 1001 E Jackson St Hugo |
State: | OK US |
Postal Code: | 747434225 |
Phone Number: | 5803179000 |
Fax Number: | |
NPI Enumeration Date: | 03/13/2015 |
NPI Last Update Date: | 03/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 83065 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |