Healthcare Provider Details

I. General information

NPI: 1386002327
Provider Name (Legal Business Name): NEW LIFE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5018 E 68TH ST
TULSA OK
74136
US

IV. Provider business mailing address

5018 E 68TH ST
TULSA OK
74136-3367
US

V. Phone/Fax

Practice location:
  • Phone: 918-932-2057
  • Fax: 918-932-2058
Mailing address:
  • Phone: 918-932-2057
  • Fax: 918-932-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW D ADCOCK
Title or Position: VP
Credential:
Phone: 918-932-2057