Healthcare Provider Details

I. General information

NPI: 1174248967
Provider Name (Legal Business Name): ST. JOHN ASCENSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S WHEELING AVE STE 606
TULSA OK
74104-5635
US

IV. Provider business mailing address

1919 S WHEELING AVE STE 606
TULSA OK
74104-5635
US

V. Phone/Fax

Practice location:
  • Phone: 918-748-7878
  • Fax:
Mailing address:
  • Phone: 918-748-7878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD D RANNE
Title or Position: PEDIATRIC SURGEON
Credential: MD
Phone: 918-748-7878