Healthcare Provider Details

I. General information

NPI: 1790722239
Provider Name (Legal Business Name): NEUROLOGIC SERVICES OF OKLAHOMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 E 21ST STREET STE 500
TULSA OK
74114-1723
US

IV. Provider business mailing address

PO BOX 59001 DEPT 4012
TULSA OK
74159-9001
US

V. Phone/Fax

Practice location:
  • Phone: 918-743-5552
  • Fax: 918-743-5553
Mailing address:
  • Phone: 918-743-5552
  • Fax: 918-743-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateOK

VIII. Authorized Official

Name: STEVE THOMAS
Title or Position: CEO
Credential:
Phone: 918-743-5552