NPIMap

Organization Active NPI

Jean E Forsberg PLLC

  • Clinical Medical Laboratory
  • Elk City, OK
National Provider Identifier
1336458215
Registry record updated Mar 18, 2011
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Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
37D0472420 Issued in OK
Legal business name
JEAN E FORSBERG PLLC
Practice address
1801 W 3Rd St
Elk City, OK 73644-5145
Phone
(580) 225-2511
NPI assigned
Sep 27, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rosie Cheadle
Title
Billing Supervisor
Phone
(405) 705-2644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 37D0472420 OK Primary

Addresses

Primary practice location

1801 W 3Rd St
Elk City, OK 73644-5145

Mailing address

PO Box 268996
Oklahoma City, OK 73126-8996
Phone (405) 705-0018

Other identifiers 1

IdentifierTypeStateIssuer
200317000AMedicaidOK

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300406400000",
    "number": "1336458215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268996",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731268996",
            "telephone_number": "405-705-0018",
            "fax_number": "405-705-0029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W 3RD ST",
            "city": "ELK CITY",
            "state": "OK",
            "postal_code": "736445145",
            "telephone_number": "580-225-2511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEAN E FORSBERG PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-27",
        "last_updated": "2011-03-18",
        "status": "A",
        "authorized_official_last_name": "CHEADLE",
        "authorized_official_first_name": "ROSIE",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "405-705-2644"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OK",
            "license": "37D0472420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200317000A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.