Basic Information
| Provider Information | |||||||||
| NPI: | 1134693245 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HCC OF BORGER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 96118 | ||||||||
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| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731436118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009623303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 MEDICAL DR | ||||||||
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| City: | BORGER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 790077579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669318882 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2019 | ||||||||
| LastUpdateDate: | 10/10/2019 | ||||||||
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| AuthorizedOfficialLastName: | WEISS | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8669318882 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.