Healthcare Provider Details

I. General information

NPI: 1588198816
Provider Name (Legal Business Name): MILESTONES MEDICAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 S MINGO RD
TULSA OK
74146-3633
US

IV. Provider business mailing address

4125 S MINGO RD
TULSA OK
74146-3633
US

V. Phone/Fax

Practice location:
  • Phone: 918-745-0800
  • Fax:
Mailing address:
  • Phone: 918-745-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. NAOMI JONES
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 918-745-0800