Healthcare Provider Details

I. General information

NPI: 1487116612
Provider Name (Legal Business Name): ALLERGY RELIEF OF SOUTH TULSA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9940 E 81ST ST STE 100
TULSA OK
74133-4501
US

IV. Provider business mailing address

9940 E 81ST ST STE 100
TULSA OK
74133-4501
US

V. Phone/Fax

Practice location:
  • Phone: 918-893-9240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTY PHILLIPS
Title or Position: DIRECTOR OF BUSINESS AFFAIRS
Credential:
Phone: 918-893-9240