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General NPI Number Information
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NPI Number | 1508493784
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Entity Type | Organization
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Legal Business Name | SQUAREONE COMPASSION INC
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 12/31/2021
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Provider Practice Location Address
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Address Line | 5323 SOUTH 65TH WEST AVENUE
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City | TULSA
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State | OK
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Zip | 74107
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Country | US
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Telephone | 918-340-5024
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Fax |
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Provider Business Mailing Address
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Address Line | 5323 SOUTH 65TH WEST AVENUE
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City | TULSA
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State | OK
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Zip | 74107
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Country | US
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Telephone | 918-340-5024
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MATTHEW RILEY BLAIR
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Credential |
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Telephone | 918-521-4185
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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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