Healthcare Provider Details

I. General information

NPI: 1023009255
Provider Name (Legal Business Name): TULSA - HILLCREST EMERGENCY PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 08/22/2020
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

4500 S GARNETT RD SUITE 919
TULSA OK
74146-5229
US

V. Phone/Fax

Practice location:
  • Phone: 918-728-6194
  • Fax: 918-664-2521
Mailing address:
  • Phone: 918-728-6194
  • Fax: 918-664-2521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY DAVID DIXON
Title or Position: PRESIDENT
Credential: MD
Phone: 918-728-6194