Organization
JEAN E FORSBERG PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSIE CHEADLE (BILLING SUPERVISOR)
(405) 705-2644
Entity
Organization
Contact information
Practice address
1801 W 3RD ST, ELK CITY, OK 73644-5145
(580) 225-2511
Mailing address
PO BOX 268996, OKLAHOMA CITY, OK 73126-8996
(405) 705-0018
(405) 705-0029
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
37D0472420
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200317000A
—
OK
Enumeration date
09/27/2010
Last updated
03/18/2011
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