Provider Demographics
NPI:1255187464
Name:ADA MEN'S CLINIC LLC
Entity type:Organization
Organization Name:ADA MEN'S CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:L
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:CHOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:580-967-6700
Mailing Address - Street 1:729 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-5613
Mailing Address - Country:US
Mailing Address - Phone:580-967-6700
Mailing Address - Fax:
Practice Address - Street 1:729 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5613
Practice Address - Country:US
Practice Address - Phone:580-967-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care