Healthcare Provider Details

I. General information

NPI: 1336983899
Provider Name (Legal Business Name): BEDSIDE MANNER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W 125TH PL S STE 202
GLENPOOL OK
74033-5026
US

IV. Provider business mailing address

303 E A ST
JENKS OK
74037-4285
US

V. Phone/Fax

Practice location:
  • Phone: 918-528-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRAVIS WOLFF
Title or Position: CEO
Credential:
Phone: 918-528-5500