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General NPI Number Information
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NPI Number | 1790101194
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Entity Type | Organization
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Legal Business Name | MEDRITE LLC
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Dates
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Enumeration Date | 03/10/2014
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Last Update Date | 03/10/2014
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Provider Practice Location Address
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Address Line | 7307 S YALE AVE STE 102
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City | TULSA
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State | OK
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Zip | 74136-7028
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Country | US
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Telephone | 918-740-7350
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Fax |
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Provider Business Mailing Address
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Address Line | 12312 S ASH AVE
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City | JENKS
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State | OK
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Zip | 74037-4994
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Country | US
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Telephone | 918-740-7350
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. BENJAMIN F BRADLEY
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Credential | APRN
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Telephone | 918-740-7350
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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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