# 456678LIFE GATE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215298898
- **Authorized official:** BILL BATEMAN (DIRECTOR)
- **Authorized official phone:** (918) 902-3770

## Contact information

- **Practice address:** 10922 E 39TH STREET SOUTH, TULSA, OK 74146-2703
- **Practice address phone:** (918) 378-6912
- **Mailing address:** 10922 E 39TH ST, TULSA, OK 74146-2703
- **Mailing address phone:** (918) 378-6912

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 05/31/2012
- **Last updated:** 05/31/2012