Organization
15TH STREET CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD POOLE II (OWNER)
(405) 420-3937
Entity
Organization
Contact information
Practice address
180 W 15TH ST STE 100, EDMOND, OK 73013-3601
(405) 420-3937
Mailing address
180 W 15TH ST STE 100, EDMOND, OK 73013-3601
(405) 420-3937
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
05/20/2019
Last updated
05/20/2019
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