Healthcare Provider Details

I. General information

NPI: 1114326451
Provider Name (Legal Business Name): TULSA NEURO TESTING, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9521 RIVERSIDE PKWY SUIYE B, #338
TULSA OK
74137-7418
US

IV. Provider business mailing address

PO BOX 21568 DEPT 323
TULSA OK
74121-1568
US

V. Phone/Fax

Practice location:
  • Phone: 214-675-0905
  • Fax: 214-317-4888
Mailing address:
  • Phone: 214-675-0905
  • Fax: 214-317-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: JAYEN PATEL
Title or Position: OWNER
Credential:
Phone: 214-675-0905