NPIMap

Organization Active NPI

Elmbrook Clinical Services LLC

  • Gerontology Nurse Practitioner
  • Ardmore, OK
National Provider Identifier
1649951211
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
Legal business name
ELMBROOK CLINICAL SERVICES LLC
Practice address
1908 12TH Ave NW
Suite E
Ardmore, OK 73401-1255
Phone
(580) 226-3055
Fax
(580) 226-3121
NPI assigned
Jul 27, 2023
Last updated
Jan 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

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

Authorized official

Name
Mr. Tom C Coble
Title
Sole Member/Initial Manager
Phone
(580) 220-7093

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU
Gerontology Nurse Practitioner 363LG0600X NU Primary
Primary Care Nurse Practitioner 363LP2300X NU

Addresses

Primary practice location

1908 12TH Ave NW
Suite E
Ardmore, OK 73401-1255

Mailing address

1908 12TH Ave NW
Suite E
Ardmore, OK 73401-1255
Phone (580) 226-3055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231101001543 OK Part B Supplier - Clinic/Group Practice 3870949548 Receives reassigned benefits from 5 practitioners
Practice locations: Ardmore, OK

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1690416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704412800000",
    "number": "1649951211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1908 12TH AVE NW",
            "address_2": "SUITE E",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011255",
            "telephone_number": "580-226-3055",
            "fax_number": "580-226-3121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1908 12TH AVE NW",
            "address_2": "SUITE E",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011255",
            "telephone_number": "580-226-3055",
            "fax_number": "580-226-3121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELMBROOK CLINICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-27",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A",
        "authorized_official_last_name": "COBLE",
        "authorized_official_first_name": "TOM",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "SOLE MEMBER/INITIAL MANAGER",
        "authorized_official_telephone_number": "580-220-7093",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.