Healthcare Provider Details

I. General information

NPI: 1497766000
Provider Name (Legal Business Name): CLINICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E MAIN
BEGGS OK
74421-0478
US

IV. Provider business mailing address

PO BOX 478
BEGGS OK
74421-0478
US

V. Phone/Fax

Practice location:
  • Phone: 918-267-7000
  • Fax: 918-267-7077
Mailing address:
  • Phone: 918-267-7000
  • Fax: 918-267-7077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KERRI LEE ELLIS
Title or Position: OWNER/ADMINISTRATOR
Credential: FNP-C
Phone: 918-367-0010