Healthcare Provider Details

I. General information

NPI: 1982926994
Provider Name (Legal Business Name): OKLAHOMA VEIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9906 RIVERSIDE PKWY
TULSA OK
74137-7409
US

IV. Provider business mailing address

7322 E 91ST ST
TULSA OK
74133-6016
US

V. Phone/Fax

Practice location:
  • Phone: 918-298-8080
  • Fax: 918-528-3841
Mailing address:
  • Phone: 918-392-0880
  • Fax: 918-392-0990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAULA J. MANLY
Title or Position: OFFICE MANAGER
Credential:
Phone: 918-392-0880