Provider Demographics
NPI:1497766000
Name:CLINICO LLC
Entity Type:Organization
Organization Name:CLINICO LLC
Other - Org Name:CLINICO RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:918-367-0010
Mailing Address - Street 1:PO BOX 478
Mailing Address - Street 2:
Mailing Address - City:BEGGS
Mailing Address - State:OK
Mailing Address - Zip Code:74421-0478
Mailing Address - Country:US
Mailing Address - Phone:918-267-7000
Mailing Address - Fax:918-267-7077
Practice Address - Street 1:103 E MAIN
Practice Address - Street 2:
Practice Address - City:BEGGS
Practice Address - State:OK
Practice Address - Zip Code:74421-0478
Practice Address - Country:US
Practice Address - Phone:918-267-7000
Practice Address - Fax:918-267-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100708410BMedicaid
OK100708410BMedicaid