Provider Demographics
NPI:1649951211
Name:ELMBROOK CLINICAL SERVICES LLC
Entity type:Organization
Organization Name:ELMBROOK CLINICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/INITIAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:C
Authorized Official - Last Name:COBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-220-7093
Mailing Address - Street 1:1908 12TH AVE NW
Mailing Address - Street 2:SUITE E
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1255
Mailing Address - Country:US
Mailing Address - Phone:580-226-3055
Mailing Address - Fax:580-226-3121
Practice Address - Street 1:1908 12TH AVE NW
Practice Address - Street 2:SUITE E
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1255
Practice Address - Country:US
Practice Address - Phone:580-226-3055
Practice Address - Fax:580-226-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty