1053740050 NPI number — OSTEOPATHIC PHYSICIANS OF TULSA, INC

Table of content: (NPI 1053740050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053740050 NPI number — OSTEOPATHIC PHYSICIANS OF TULSA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSTEOPATHIC PHYSICIANS OF TULSA, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEPHROLOGY SPECIALISTS OF TULSA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053740050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT 2761
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74182-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-582-3154
Provider Business Mailing Address Fax Number:
918-582-3593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6465 S YALE AVE
Provider Second Line Business Practice Location Address:
STE 401
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74136-7823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-582-1354
Provider Business Practice Location Address Fax Number:
918-582-3593
Provider Enumeration Date:
11/11/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WELLS
Authorized Official First Name:
APRIL
Authorized Official Middle Name:
DIANE
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
918-582-3154

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)