Organization
MEDWISE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS SIDNEY BLACKSTAD (PRESIDENT)
(918) 605-6582
Entity
Organization
Contact information
Practice address
11495 S. STATE HIGHWAY 51, COWETA, OK 74429
(225) 936-9186
Mailing address
12902 E 51ST ST, TULSA, OK 74134-6712
(918) 605-6582
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Enumeration date
03/13/2020
Last updated
10/24/2024
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