Healthcare Provider Details

I. General information

NPI: 1477821734
Provider Name (Legal Business Name): JANIE TUBB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 N CLASSEN BLVD SUIT 101
OKLAHOMA CITY OK
73118-3231
US

IV. Provider business mailing address

3601 N CLASSEN BLVD SUIT 101
OKLAHOMA CITY OK
73118-3231
US

V. Phone/Fax

Practice location:
  • Phone: 405-528-5263
  • Fax: 405-601-3750
Mailing address:
  • Phone: 405-528-5263
  • Fax: 405-601-3750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW 1522
License Number StateOK

VIII. Authorized Official

Name: DEBRA J PARRISH
Title or Position: OFFICE MANAGER
Credential:
Phone: 405-601-0954