Organization
EVOLUTION HAIR CARE,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHIRON JANEAN BULLOCK (HAIR LOSS SPECIALIST)
(405) 501-6402
Entity
Organization
Contact information
Practice address
11102 STRATFORD DR STE B200, OKLAHOMA CITY, OK 73120-7263
(405) 501-6402
Mailing address
12429 PITTSBURGH AVE, OKLAHOMA CITY, OK 73120-6000
(405) 501-6402
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
94711
OK
302F00000X
Exclusive Provider Organization
94711
OK
305R00000X
Preferred Provider Organization
94711
OK
305S00000X
Point of Service
94711
OK
332BC3200X
Customized Equipment (DME)
94711
OK
335E00000X
Prosthetic/Orthotic Supplier
Primary
94711
OK
Other
Enumeration date
08/26/2016
Last updated
08/26/2016
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