Healthcare Provider Details

I. General information

NPI: 1912090218
Provider Name (Legal Business Name): TULSA HAND SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S WHEELING SUITE 910
TULSA OK
74104-5647
US

IV. Provider business mailing address

2000 S WHEELING SUITE 910
TULSA OK
74104-5647
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-1418
  • Fax: 918-749-6241
Mailing address:
  • Phone: 918-749-1418
  • Fax: 918-749-6241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL B CLENDENIN
Title or Position: PRESIDENT
Credential: MD
Phone: 918-749-1418