Healthcare Provider Details

I. General information

NPI: 1790142784
Provider Name (Legal Business Name): VIZARC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NW 7TH ST
OKLAHOMA CITY OK
73102-1212
US

IV. Provider business mailing address

700 NW 7TH ST
OKLAHOMA CITY OK
73102-1212
US

V. Phone/Fax

Practice location:
  • Phone: 405-553-1272
  • Fax:
Mailing address:
  • Phone: 405-553-1272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateOK

VIII. Authorized Official

Name: TOM TUCKER
Title or Position: OWNER
Credential:
Phone: 405-609-3600