Idabel Children's Clinic, Inc.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

22507 Issued in OK

Legal business name

IDABEL CHILDREN'S CLINIC, INC.

Practice address

1307 Lynn LN
Idabel, OK 74745-6845

Phone

(580) 286-5437

Fax

(580) 286-3955

NPI assigned

Jun 28, 2010

Last updated

Jul 28, 2010By 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

Dr. Robert Dellino Leboeuf, PH.D.

Title

Office Manager

Phone

(580) 212-2697

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1277683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280275200000",
    "number": "1689985343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 LYNN LN",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747456845",
            "telephone_number": "580-286-5437",
            "fax_number": "580-286-3955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 LYNN LN",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747456845",
            "telephone_number": "580-286-5437",
            "fax_number": "580-286-3955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDABEL CHILDREN'S CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-28",
        "last_updated": "2010-07-28",
        "status": "A",
        "authorized_official_last_name": "LEBOEUF",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "DELLINO",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "580-212-2697",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "OK",
            "license": "22507",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100187600B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Home Run Healthcare
• Hometown Quality Care, Inc. I
• John Hoskins, M.D.
• Hospice Center of Southeastern Oklahoma, Inc
• April L Hurst, PT
• Idabel Chiropractic Clinic PLLC
• Idabel Express Pharmacy, LLC (Idabel Express Pharmacy)
• Idabel Family Practice, LLC
• Idabel Health & Rehabilitation Center, LLC (Oak Grove Manor)
• Idabel Public Schools

• Primary Care Clinic/Center in Idabel, OK
• Providers in Idabel, OK by specialty
• Primary Care Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2010; 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.