Organization
CARESOURCE-TULSA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY PIERCE (EXECUTIVE DIRECTOR)
(405) 948-2822
Entity
Organization
Contact information
Practice address
1400 SW EXPRESSWAY DR, BROKEN ARROW, OK 74012
(918) 250-7051
(918) 392-3442
Mailing address
PO BOX 270214, OKLAHOMA CITY, OK 73137-0214
(918) 250-7051
(918) 392-3442
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200074940A
—
OK
Enumeration date
08/25/2006
Last updated
07/21/2022
Update your record
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