Basic Information
| Provider Information | |||||||||
| NPI: | 1730606518 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOCHATOWN MEDICAL CLINIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6966 S UTICA AVE STE 225 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741363903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184926333 | ||||||||
| FaxNumber: | 9184939405 | ||||||||
| Practice Location | |||||||||
| Address1: | 6613 N US HIGHWAY 259 | ||||||||
| Address2: | |||||||||
| City: | BROKEN BOW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747286591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186892500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | HOGAN | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9186892500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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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 |
No ID Information.