Organization
HOME RUN HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEI JOBE NURSE PRACTIONER (PRESIDENT)
(580) 212-7237
Entity
Organization
Contact information
Practice address
1425 EAST LINCOLN ROAD, SUITE A-3, IDABEL, OK 74745
(580) 212-7237
Mailing address
PO BOX 51, GARVIN, OK 74736-0051
(580) 212-7237
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679013676
—
OK
Enumeration date
06/25/2018
Last updated
06/25/2018
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