Organization
MEDWISE LLC
Active
Parent organization
MEDWISE LLC
Other names
MedWise LLC - Broken Arrow East
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
2550 N 9TH ST, BROKEN ARROW, OK 74012-2897
(918) 727-2850
Mailing address
12902 E 51ST ST, TULSA, OK 74134-6712
(918) 994-3476
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Enumeration date
02/04/2025
Last updated
02/04/2025
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