Healthcare Provider Details

I. General information

NPI: 1205829025
Provider Name (Legal Business Name): EASTERN OKLAHOMA EAR NOSE AND THROAT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 E 68TH ST
TULSA OK
74136-3307
US

IV. Provider business mailing address

5020 E 68TH ST
TULSA OK
74136-3307
US

V. Phone/Fax

Practice location:
  • Phone: 918-429-3636
  • Fax: 918-494-8915
Mailing address:
  • Phone: 918-429-3636
  • Fax: 918-494-8915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHARLES E HEINBERG
Title or Position: PRESIDENT
Credential:
Phone: 918-492-3636