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General NPI Number Information
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NPI Number | 1639709546
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Entity Type | Organization
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Legal Business Name | MPP INFUSION CENTER OF TULSA, LLC
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Dates
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Enumeration Date | 01/20/2020
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 8806 S YALE AVE STE B
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City | TULSA
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State | OK
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Zip | 74137-3712
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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 | 1726 COLE BLVD STE 250
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City | LAKEWOOD
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State | CO
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Zip | 80401-3262
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Country | US
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Telephone | 720-465-5030
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Fax | 720-465-5030
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | SUE ELLEN ROTTURA
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Credential |
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Telephone | 561-323-8987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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