Healthcare Provider Details

I. General information

NPI: 1194396721
Provider Name (Legal Business Name): OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 E 19TH ST FL 5
TULSA OK
74104-5407
US

IV. Provider business mailing address

12697 E 51ST ST
TULSA OK
74146-6236
US

V. Phone/Fax

Practice location:
  • Phone: 918-505-3200
  • Fax: 918-505-3225
Mailing address:
  • Phone: 918-499-2141
  • Fax: 918-499-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY M DREESEN
Title or Position: MGD CARE & CRED COOR
Credential:
Phone: 918-499-2141