Healthcare Provider Details

I. General information

NPI: 1003149741
Provider Name (Legal Business Name): TULSA SPECIALTY HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 S 79TH EAST AVE
TULSA OK
74145-1343
US

IV. Provider business mailing address

4400 WILL ROGERS PKWY STE 105
OKLAHOMA CITY OK
73108-1837
US

V. Phone/Fax

Practice location:
  • Phone: 918-663-8183
  • Fax:
Mailing address:
  • Phone: 405-947-5557
  • Fax: 405-948-6507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH NEAL
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 405-947-5557