Healthcare Provider Details

I. General information

NPI: 1780857540
Provider Name (Legal Business Name): AHS OKLAHOMA HEART LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9228 S MINGO RD SUITE 200
TULSA OK
74133-5718
US

IV. Provider business mailing address

9228 S MINGO RD SUITE 200
TULSA OK
74133-5718
US

V. Phone/Fax

Practice location:
  • Phone: 918-592-0999
  • Fax: 918-878-2499
Mailing address:
  • Phone: 918-592-0999
  • Fax: 918-878-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN C. PETROVICH
Title or Position: EVP GENERAL COUNSEL
Credential:
Phone: 615-296-3594