Provider Demographics
NPI:1073210993
Name:CLOVER OXYGEN PLLC
Entity Type:Organization
Organization Name:CLOVER OXYGEN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHUAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-336-7643
Mailing Address - Street 1:800 8TH AVE STE 506
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2604
Mailing Address - Country:US
Mailing Address - Phone:214-336-7643
Mailing Address - Fax:866-245-0073
Practice Address - Street 1:252 BAILEY RANCH ROAD
Practice Address - Street 2:STE 100
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008
Practice Address - Country:US
Practice Address - Phone:817-386-3632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty