Organization
ALLERGY CLINIC OF TULSA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA THOMAS (BUSINESS OFFICE MANAGER)
(918) 307-1613
Entity
Organization
Contact information
Practice address
9311 S MINGO RD, TULSA, OK 74133-5702
(918) 307-1613
(918) 307-2454
Mailing address
9311 S MINGO RD, TULSA, OK 74133-5702
(918) 307-1613
(918) 307-2454
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6713610001
MEDICARE DMERC PTAN
OK
Enumeration date
08/31/2006
Last updated
09/27/2013
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