Healthcare Provider Details

I. General information

NPI: 1346528718
Provider Name (Legal Business Name): HIV RESOURCE CONSORTIUM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date: 10/18/2019
Reactivation Date: 10/23/2019

III. Provider practice location address

3712 E 11TH ST
TULSA OK
74112-3952
US

IV. Provider business mailing address

3712 E 11TH ST
TULSA OK
74112-3952
US

V. Phone/Fax

Practice location:
  • Phone: 918-834-4194
  • Fax: 918-834-4189
Mailing address:
  • Phone: 918-834-4194
  • Fax: 918-834-4189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: CINDY AKKERMAN
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 918-924-5156