MEDICARE: MS. HELEN RUTH BOAZ

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	347C00000X	Private Vehicle		OK

General Provider Information

NPI Number	:	1962610170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HELEN RUTH BOAZ

Provider Business Mailing Address
First Line	:	6122 S 35TH WEST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-1230
Country	:	US
Telephone Number	:	918-446-3853
Fax Number	:	918-446-3853

Provider Business Practice Location Address
First Line	:	6122 S 35TH WEST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-1230
Country	:	US
Telephone Number	:	918-446-3853
Fax Number	:	918-446-3853

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2007
Last Update Date	:	07/08/2007

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