Healthcare Provider Details

I. General information

NPI: 1063968352
Provider Name (Legal Business Name): THOMAS LUISKUTTY MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6910 E 111TH PL S
BIXBY OK
74008-2066
US

IV. Provider business mailing address

6910 E 111TH PL S
BIXBY OK
74008-2066
US

V. Phone/Fax

Practice location:
  • Phone: 918-630-7600
  • Fax:
Mailing address:
  • Phone: 918-640-4425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS LUISKUTTY
Title or Position: MANAGER
Credential: M.D.
Phone: 918-640-4425