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General NPI Number Information
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NPI Number | 1073658092
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL SERVICES OF TULSA P C
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 3316 E 21ST ST SUITE A
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City | TULSA
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State | OK
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Zip | 74114-1967
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Country | US
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Telephone | 918-749-3533
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Fax | 918-749-9789
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Provider Business Mailing Address
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Address Line | 3316 E 21ST ST SUITE A
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City | TULSA
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State | OK
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Zip | 74114-1967
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Country | US
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Telephone | 918-749-3533
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Fax | 918-749-9789
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERENCE E. GREWE
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Credential | DO
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Telephone | 918-749-3533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 207Q00000X
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License Number State | OK
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