Healthcare Provider Details

I. General information

NPI: 1902344484
Provider Name (Legal Business Name): AHS HILLCREST MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S UTICA AVE
TULSA OK
74104-4012
US

IV. Provider business mailing address

1120 S UTICA AVE
TULSA OK
74104-4012
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-9018
  • Fax: 918-579-8013
Mailing address:
  • Phone: 918-579-9018
  • Fax: 918-579-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN C PETROVICH
Title or Position: EVP
Credential:
Phone: 615-296-3000