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General NPI Number Information
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NPI Number | 1194396721
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Entity Type | Organization
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Legal Business Name | OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE, LLC
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 1819 E 19TH ST FL 5
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City | TULSA
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State | OK
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Zip | 74104-5407
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Country | US
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Telephone | 918-505-3200
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Fax | 918-505-3225
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Provider Business Mailing Address
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Address Line | 12697 E 51ST ST
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City | TULSA
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State | OK
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Zip | 74146-6236
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Country | US
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Telephone | 918-499-2141
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Fax | 918-499-2141
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Authorized Official
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Title or Position | MGD CARE & CRED COOR
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Name | MARY M DREESEN
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Credential |
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Telephone | 918-499-2141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number |
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License Number State |
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