# ELMBROOK CLINICAL SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649951211
- **Authorized official:** MR. TOM C COBLE (SOLE MEMBER/INITIAL MANAGER)
- **Authorized official phone:** (580) 220-7093

## Contact information

- **Practice address:** 1908 12TH AVE NW, SUITE E, ARDMORE, OK 73401-1255
- **Practice address phone:** (580) 226-3055
- **Practice address fax:** (580) 226-3121
- **Mailing address:** 1908 12TH AVE NW, SUITE E, ARDMORE, OK 73401-1255
- **Mailing address phone:** (580) 226-3055
- **Mailing address fax:** (580) 226-3121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/27/2023
- **Last updated:** 01/05/2024