Organization
MEDWISE LLC
Active
Parent organization
MEDWISE LLC
Other names
MedWise Urgent Care - Tahlequah
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDWISE LLC
Authorized official
DENNIS SIDNEY BLACKSTAD MD (PRESIDENT)
(918) 605-6582
Entity
Organization
Contact information
Practice address
1930 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-5437
(918) 998-9970
Mailing address
12902 E 51ST ST, TULSA, OK 74134-6712
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
03/17/2025
Last updated
03/17/2025
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