Healthcare Provider Details

I. General information

NPI: 1811907538
Provider Name (Legal Business Name): OMEGA PRACTICE MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 S. UTICA STE 901
TULSA OK
74104-4013
US

IV. Provider business mailing address

9130 E 77TH ST
TULSA OK
74133-4922
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-7071
  • Fax: 918-392-7072
Mailing address:
  • Phone:
  • 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: DR. ANIL K REDDY
Title or Position: PHYSICAL MEDICINE & REHABILITIATION
Credential: M.D.
Phone: 918-392-7071