Healthcare Provider Details

I. General information

NPI: 1124355334
Provider Name (Legal Business Name): HEART INSTITUTE OF TULSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 COUNTY ROAD 675
MOUNTAIN HOME AR
72653-9834
US

IV. Provider business mailing address

5055 KELLER SPRINGS RD SUITE 500
ADDISON TX
75001-5997
US

V. Phone/Fax

Practice location:
  • Phone: 870-491-5555
  • Fax: 870-491-7638
Mailing address:
  • Phone: 214-242-8500
  • Fax: 214-242-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CHRIS TURNER
Title or Position: CEO
Credential:
Phone: 214-242-8500