Organization Name: | SOUTH TULSA MEDICAL GROUP LLC |
NPI Number: | 1518998483 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT) |
Mailing Address: | 8803 S 101st East Ave Ste 100 Tulsa |
State: | OK US |
Postal Code: | 741335726 |
Phone Number: | 9183925470 |
Fax Number: | |
NPI Enumeration Date: | 07/06/2006 |
NPI Last Update Date: | 09/09/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |