Organization
N/A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
N/A N/A (N/A)
(111) 222-3333
Entity
Organization
Contact information
Practice address
4502 E 41ST ST, TULSA, OK 74135-2536
(918) 579-2367
Mailing address
4502 E 41ST ST, TULSA, OK 74135-2536
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/09/2015
Last updated
05/09/2015
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