Healthcare Provider Details

I. General information

NPI: 1215663216
Provider Name (Legal Business Name): TYREN HILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E APACHE ST
TULSA OK
74106-3702
US

IV. Provider business mailing address

2305 W NEWTON PL
TULSA OK
74127-3024
US

V. Phone/Fax

Practice location:
  • Phone: 918-794-0197
  • Fax:
Mailing address:
  • Phone: 918-856-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: