Organization
SHELLY JACOBS MD PLLC
Active
Other names
Suboxone and Wellness Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KHANG TRUONG (BUSINESS MANAGER)
(405) 532-3176
Entity
Organization
Contact information
Practice address
6424 N PORTLAND AVE, OKLAHOMA CITY, OK 73116-2012
(405) 757-4643
Mailing address
6424 N PORTLAND AVE, OKLAHOMA CITY, OK 73116-2012
(405) 757-4643
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
09/12/2022
Last updated
09/12/2022
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