Organization
456678LIFE GATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BILL BATEMAN (DIRECTOR)
(918) 902-3770
Entity
Organization
Contact information
Practice address
10922 E 39TH STREET SOUTH, TULSA, OK 74146-2703
(918) 378-6912
Mailing address
10922 E 39TH ST, TULSA, OK 74146-2703
(918) 378-6912
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
05/31/2012
Last updated
05/31/2012
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