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General NPI Number Information
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NPI Number | 1336553502
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Entity Type | Organization
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Legal Business Name | MEDRITE LLC
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 06/30/2015
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Provider Practice Location Address
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Address Line | 7307 S YALE AVE STE 101
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City | TULSA
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State | OK
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Zip | 74136-7028
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Country | US
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Telephone | 918-710-2062
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Fax |
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Provider Business Mailing Address
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Address Line | 109 W 6TH ST
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City | OKMULGEE
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State | OK
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Zip | 74447-5015
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Country | US
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Telephone | 918-779-0709
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Fax | 918-392-4552
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Authorized Official
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Title or Position | CEO
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Name | MR. BENJAMIN BRADLEY
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Credential | APRN
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Telephone | 918-779-0709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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