HCC of Shattuck, LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

HCC OF SHATTUCK, LLC

Practice address

905 S Main St
Shattuck, OK 73858-9205

Phone

(580) 938-2551

NPI assigned

Oct 28, 2019

Last updated

Oct 28, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dawn Bolar

Title

Ceo

Phone

(972) 934-3200

Specialties & licenses 1

Addresses

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635379200000",
    "number": "1124661624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7725 W RENO AVE STE 150",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731279712",
            "telephone_number": "800-962-3303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 S MAIN ST",
            "city": "SHATTUCK",
            "state": "OK",
            "postal_code": "738589205",
            "telephone_number": "580-938-2551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HCC OF SHATTUCK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-28",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A",
        "authorized_official_last_name": "BOLAR",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "972-934-3200"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Shattuck",
            "affiliation": "N",
            "endpointDescription": "Hospital",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "905 S Main St",
            "city": "Shattuck",
            "state": "OK",
            "country_code": "US",
            "postal_code": "738589205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• John Rodney Cully, DPH
• Ellis County EMS
• Michael W. Flaherty, MD
• Foundation Health & Wellness Institute PC
• Gary A. Frederick, M.D.
• John David Herber, R.PH., D.PH.
• Jennifer Hix
• Kristen a Burris, D.D.S. L.L.C.
• Gary Willis Mitchell, D.PH.
• Merindy Grace Morgenson, MD

• Emergency Medicine Physician in Shattuck, OK
• Providers in Shattuck, OK by specialty
• Emergency Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.