Organization
IDABEL CHILDREN'S CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT DELLINO LEBOEUF PH.D. (OFFICE MANAGER)
(580) 212-2697
Entity
Organization
Contact information
Practice address
1307 LYNN LN, IDABEL, OK 74745-6845
(580) 286-5437
(580) 286-3955
Mailing address
1307 LYNN LN, IDABEL, OK 74745-6845
(580) 286-5437
(580) 286-3955
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
22507
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100187600B
—
OK
Enumeration date
06/28/2010
Last updated
07/28/2010
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