1548762982 NPI number — MR. LLOYD DEAN HILBURN

Table of content: MR. LLOYD DEAN HILBURN (NPI 1548762982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548762982 NPI number — MR. LLOYD DEAN HILBURN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILBURN
Provider First Name:
LLOYD
Provider Middle Name:
DEAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548762982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 N. BROADWAY
Provider Second Line Business Mailing Address:
P.O. BOX 99
Provider Business Mailing Address City Name:
CARNEGIE
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-654-1439
Provider Business Mailing Address Fax Number:
580-654-2637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 N. BROADWAY
Provider Second Line Business Practice Location Address:
P.O. BOX 99
Provider Business Practice Location Address City Name:
CARNEGIE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-654-1439
Provider Business Practice Location Address Fax Number:
580-654-2637
Provider Enumeration Date:
03/01/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 376G00000X , with the licence number:  1195 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100774209370E24 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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