Organization
SOUTH TULSA MEDICAL GROUP LLC
Active
Organization
SOUTH TULSA MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(877) 892-9813
Entity
Organization
Contact information
Practice address
8803 S 101ST EAST AVE, STE 100, TULSA, OK 74133-5726
(918) 392-5470
Mailing address
7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208D00000X
General Practice Physician
—
—
364S00000X
Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200106940A
—
OK
Enumeration date
07/06/2006
Last updated
09/09/2008
Update your record
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