Healthcare Provider Details

I. General information

NPI: 1619475696
Provider Name (Legal Business Name): TULSA PODIATRY CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 W 15TH ST STE 500C
EDMOND OK
73013-3672
US

IV. Provider business mailing address

PO BOX 5231
EDMOND OK
73083-5231
US

V. Phone/Fax

Practice location:
  • Phone: 405-471-6190
  • Fax: 405-285-8900
Mailing address:
  • Phone: 405-816-6266
  • Fax: 405-285-8921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MR. CHAD E HUFFMYER
Title or Position: CEO
Credential:
Phone: 405-816-6266