Healthcare Provider Details

I. General information

NPI: 1447878269
Provider Name (Legal Business Name): TULSA ACCIDENT CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5711 E 71ST ST STE 100C
TULSA OK
74136-6655
US

IV. Provider business mailing address

5711 E 71ST ST STE 100C
TULSA OK
74136-6655
US

V. Phone/Fax

Practice location:
  • Phone: 918-879-6161
  • Fax:
Mailing address:
  • Phone: 918-879-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: TREY MARLER
Title or Position: MANAGER
Credential:
Phone: 918-879-6161