MEDICARE: OKLAHOMA BRAIN TUMOR FOUNDATION

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1811202955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA BRAIN TUMOR FOUNDATION

Provider Business Mailing Address
First Line	:	730 W WILSHIRE BLVD
Second Line	:	SUITE 114
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7781
Country	:	US
Telephone Number	:	405-843-4673
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 W WILSHIRE BLVD
Second Line	:	SUITE 114
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7781
Country	:	US
Telephone Number	:	405-843-4673
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND FOUNDER
Name	:	MS. NANCY S THOMASON
Credential	:
Telephone Number	:	405-843-4673

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	08/13/2010

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