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General NPI Number Information
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NPI Number | 1518028125
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Entity Type | Organization
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Legal Business Name | EAR NOSE & THROAT CLINIC OF TULSA, INC
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4444 S HARVARD AVE #100
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City | TULSA
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State | OK
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Zip | 74135-2634
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Country | US
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Telephone | 918-744-0228
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Fax | 918-744-6613
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Provider Business Mailing Address
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Address Line | 4444 S HARVARD AVE #100
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City | TULSA
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State | OK
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Zip | 74135-2634
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Country | US
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Telephone | 918-744-0228
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Fax | 918-744-6613
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Authorized Official
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Title or Position | OFFICE ADMINISTRATION
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Name | C KATHLEEN WORRALL
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Credential |
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Telephone | 918-744-0228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number |
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License Number State |
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