Healthcare Provider Details

I. General information

NPI: 1992557730
Provider Name (Legal Business Name): THOMAS CARE CLINIC LLC TULSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 E 31ST ST
TULSA OK
74135-1500
US

IV. Provider business mailing address

2040 E SUNSHINE ST
SPRINGFIELD MO
65804-1815
US

V. Phone/Fax

Practice location:
  • Phone: 417-275-8900
  • Fax: 417-270-8012
Mailing address:
  • Phone: 417-275-8900
  • Fax: 417-270-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: URSULA HENSON
Title or Position: DIRECTOR OF OPERATIONS
Credential: RN
Phone: 417-439-1494