Organization
MARSHALL COUNTY HMA LLC
Active
Other names
INTEGRIS Kingston Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN E CLIFTON (SENIOR VICE PRESIDENT)
(239) 598-3131
Entity
Organization
Contact information
Practice address
700 E. HIGHWAY 70, KINGSTON, OK 73439
(580) 564-4944
(580) 564-4344
Mailing address
PO BOX 762, KINGSTON, OK 73439-0762
(580) 564-4944
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100091450A
—
OK
05
—
100148210A
—
OK
01
—
100700440B
MEDICAID RHC
OK
01
—
100700440E
MEDICAID SC
OK
05
—
100709210A
—
OK
01
—
731426051-002
BCBS OF OKLAHOMA
OK
Enumeration date
08/10/2005
Last updated
06/12/2013
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