Healthcare Provider Details

I. General information

NPI: 1053359588
Provider Name (Legal Business Name): PEDIATRIC CARDIOLOGY OF OKLAHOMA P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 S YALE AVE SUITE 2402
TULSA OK
74136-1907
US

IV. Provider business mailing address

6151 S YALE AVE SUITE 2402
TULSA OK
74136-1907
US

V. Phone/Fax

Practice location:
  • Phone: 918-481-4600
  • Fax: 918-481-4603
Mailing address:
  • Phone: 918-481-4600
  • Fax: 918-481-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: WES CONLEY
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 918-481-4600