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General NPI Number Information
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NPI Number | 1538981204
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Entity Type | Organization
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Legal Business Name | MEDWISE LLC
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 6336 E ADMIRAL PL
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City | TULSA
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State | OK
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Zip | 74115
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Country | US
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Telephone | 918-727-2831
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Fax |
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Provider Business Mailing Address
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Address Line | 12902 E 51ST ST
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City | TULSA
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State | OK
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Zip | 74134-6712
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Country | US
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Telephone | 918-994-3476
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENNIS SIDNEY BLACKSTAD
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Credential | MD
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Telephone | 918-605-6582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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