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Organization
ELMBROOK CLINICAL SERVICES LLC
Active
Organization
ELMBROOK CLINICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOM C COBLE (SOLE MEMBER/INITIAL MANAGER)
(580) 220-7093
Entity
Organization
Contact information
Practice address
1908 12TH AVE NW, SUITE E, ARDMORE, OK 73401-1255
(580) 226-3055
(580) 226-3121
Mailing address
1908 12TH AVE NW, SUITE E, ARDMORE, OK 73401-1255
(580) 226-3055
(580) 226-3121
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
Primary
—
NULL
363LG0600X
Gerontology Nurse Practitioner
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
NULL
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
07/27/2023
Last updated
01/05/2024
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