Organization
ST JOHN CARDIOVASCULAR MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEX ANDERSON (VICE-PRESIDENT)
(918) 744-3674
Entity
Organization
Contact information
Practice address
1923 E 21ST ST, SUITE 200, TULSA, OK 74114-1419
(918) 744-6966
(918) 744-9642
Mailing address
1923 E 21ST ST, SUITE 200, TULSA, OK 74114-1419
(918) 744-6966
(918) 744-9642
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE4213
RR MEDICARE
OK
Enumeration date
07/07/2006
Last updated
11/29/2007
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