Organization
BLACK OAK CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MEGAN ELIZABETH BLACK APRN C-NP (OWNER/NURSE PRACTITIONER)
(580) 584-3099
Entity
Organization
Contact information
Practice address
110 W 1ST ST, BROKEN BOW, OK 74728
(580) 584-3099
(580) 584-3097
Mailing address
110 W 1ST ST, BROKEN BOW, OK 74728-3902
(405) 628-8901
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200740450A
—
OK
Enumeration date
10/26/2017
Last updated
08/07/2018
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