Healthcare Provider Details

I. General information

NPI: 1114244985
Provider Name (Legal Business Name): ADULT GASTROENTEROLOGY ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S WHEELING AVE SUITE 700
TULSA OK
74104-5649
US

IV. Provider business mailing address

2000 SOUTH WHEELING SUITE 700
TULSA OK
74104
US

V. Phone/Fax

Practice location:
  • Phone: 918-749-4887
  • Fax: 918-749-4895
Mailing address:
  • Phone: 918-749-4887
  • Fax: 918-749-4895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. GARY L HILLS
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 918-749-4887