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General NPI Number Information
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NPI Number | 1053309591
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Entity Type | Organization
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Legal Business Name | CTCA PHYSICANS GROUP OF OKLAHOMA, INC
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Dates
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Enumeration Date | 10/10/2005
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 10109 E 79TH ST
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City | TULSA
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State | OK
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Zip | 74133-4564
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Country | US
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Telephone | 847-746-4358
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Fax | 847-746-4213
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Provider Business Mailing Address
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Address Line | 5900 BROKEN SOUND PKWY NW
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City | BOCA RATON
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State | FL
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Zip | 33487-2797
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF ACCOUNTING OFFICER
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Name | NEETU MASUTA
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Credential |
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Telephone | 847-342-6978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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