15th Street Clinic
Contractor in Edmond, OK. Organization (NPI-2).
NPI number1861059388
StatusActive
Last updated in NPPESMay 20, 2019
Details
- NPI
- 1861059388
- Entity type
- Organization (NPI-2)
- Legal business name
- 15th Street Clinic
- Organization subpart
- No
- Enumeration date
- May 20, 2019
- Last updated
- May 20, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 171W00000X | Contractor | – | – | Yes |
Practice location
180 W 15th St Ste 100Edmond, OK 73013-3601
Phone 405-420-3937
Mailing address
180 W 15th St Ste 100Edmond, OK 73013-3601
Phone 405-420-3937
Authorized official
Edward Poole
Owner
4054203937
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