MEDICARE: CRESTWOOD CLINIC, PC

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	261QP2300X	Primary Care Clinic/Center	23758	OK

General Provider Information

NPI Number	:	1821329574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRESTWOOD CLINIC, PC

Provider Business Mailing Address
First Line	:	4100 E 51ST ST
Second Line	:	SUITE 111
City	:	TULSA
State	:	OK
Zip	:	74135-3628
Country	:	US
Telephone Number	:	918-742-6700
Fax Number	:	918-742-6878

Provider Business Practice Location Address
First Line	:	4100 E 51ST ST
Second Line	:	SUITE 111
City	:	TULSA
State	:	OK
Zip	:	74135-3628
Country	:	US
Telephone Number	:	918-742-6700
Fax Number	:	918-742-6878

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANNE SCHLAFKE MAY
Credential	:	M.D.
Telephone Number	:	918-742-6700

Provider Enumeration Date	:	01/20/2010
Last Update Date	:	01/20/2010

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