Healthcare Provider Details

I. General information

NPI: 1336552710
Provider Name (Legal Business Name): CENTER FOR MEN'S HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5657 E 41ST ST
TULSA OK
74135-6010
US

IV. Provider business mailing address

5657 E 41ST ST
TULSA OK
74135-6010
US

V. Phone/Fax

Practice location:
  • Phone: 918-622-2500
  • Fax: 918-622-2502
Mailing address:
  • Phone: 918-622-2500
  • Fax: 918-622-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number4111
License Number StateOK

VIII. Authorized Official

Name: WILLIAM BLAINE PRICE JR.
Title or Position: PRESIDENT
Credential: D.O.
Phone: 918-645-5201