MEDICARE: TULSA CT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598710436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TULSA CT LLC

Provider Business Mailing Address
First Line	:	PO BOX 22155
Second Line	:	DEPT 1200
City	:	TULSA
State	:	OK
Zip	:	74121-2155
Country	:	US
Telephone Number	:	918-745-2299
Fax Number	:	918-745-2313

Provider Business Practice Location Address
First Line	:	1855 E 15TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-4610
Country	:	US
Telephone Number	:	918-742-8010
Fax Number	:	918-742-8088

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TIM WINERS
Credential	:
Telephone Number	:	918-492-6440

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	01/13/2009

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Directions to “TULSA CT LLC ” Practice Location

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