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General NPI Number Information
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NPI Number | 1164951901
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Entity Type | Organization
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Legal Business Name | CLAYBORN FAMILY CLINIC, LLC
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 517 N BROADWAY ST
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City | CHECOTAH
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State | OK
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Zip | 74426-1623
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Country | US
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Telephone | 918-973-2372
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Fax | 877-991-9307
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Provider Business Mailing Address
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Address Line | 517 N BROADWAY ST
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City | CHECOTAH
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State | OK
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Zip | 74426-1623
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Country | US
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Telephone | 918-973-2372
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Fax | 877-991-9307
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | ASHTON CLAYBORN
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Credential | DO
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Telephone | 918-973-2372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 5726
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License Number State | OK
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