Healthcare Provider Details

I. General information

NPI: 1598710436
Provider Name (Legal Business Name): TULSA CT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 E 15TH ST
TULSA OK
74104-4610
US

IV. Provider business mailing address

PO BOX 22155 DEPT 1200
TULSA OK
74121-2155
US

V. Phone/Fax

Practice location:
  • Phone: 918-742-8010
  • Fax: 918-742-8088
Mailing address:
  • Phone: 918-745-2299
  • Fax: 918-745-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TIM WINERS
Title or Position: PRESIDENT
Credential:
Phone: 918-492-6440