1942560669 NPI number — TULSA MEDICAL & REHAB LLC

Table of content: (NPI 1942560669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942560669 NPI number — TULSA MEDICAL & REHAB LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TULSA MEDICAL & REHAB LLC
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:
Provider Other Organization Name Type Code:
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:
1942560669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2260 N RIDGE RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67205-1132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-722-4776
Provider Business Mailing Address Fax Number:
316-722-4082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3311 S YALE AVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74135-8036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-500-9156
Provider Business Practice Location Address Fax Number:
316-722-4082
Provider Enumeration Date:
05/29/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ECK
Authorized Official First Name:
TODD
Authorized Official Middle Name:
HENRY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
316-722-4776

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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