Organization
HCC OF SHATTUCK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN BOLAR (CEO)
(972) 934-3200
Entity
Organization
Contact information
Practice address
905 S MAIN ST, SHATTUCK, OK 73858-9205
(580) 938-2551
Mailing address
7725 W RENO AVE STE 150, OKLAHOMA CITY, OK 73127-9712
(800) 962-3303
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
10/28/2019
Last updated
10/28/2021
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