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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
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