=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780972224
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TULSA UROLOGY PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2011
-----------------------------------------------------
Last Update Date | 03/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 W BOISE CIR #210
-----------------------------------------------------
City | BROKEN ARROW
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74012-4906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-872-9611
-----------------------------------------------------
Fax | 918-872-9962
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 W BOISE CIR #210
-----------------------------------------------------
City | BROKEN ARROW
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74012-4906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-872-9611
-----------------------------------------------------
Fax | 918-872-9962
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RICHARD B SAINT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 918-872-9611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 17425
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------