MEDICARE: IDOC OKLAHOMA TELEHEALTH SOLUTIONS 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	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	46695	OTHER	OK	LICENSE

General Provider Information

NPI Number	:	1649121914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDOC OKLAHOMA TELEHEALTH SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	4635 SOUTHWEST FWY STE 525
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-7157
Country	:	US
Telephone Number	:	818-378-9549
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 S YALE AVE STE 1035
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74112-1446
Country	:	US
Telephone Number	:	818-378-9549
Fax Number	:

Authorized Official
Title or Position	:	MBA
Name	:	NATALYA MELNIC
Credential	:
Telephone Number	:	818-378-9549

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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