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General NPI Number Information
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NPI Number | 1811940703
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Entity Type | Organization
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Legal Business Name | SOUTH TULSA ULTRASOUND ASSOCIATES, L.L.C.
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7712 S YALE AVE SUITE 100
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City | TULSA
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State | OK
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Zip | 74136-8332
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Country | US
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Telephone | 918-523-7226
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Fax | 918-523-7227
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Provider Business Mailing Address
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Address Line | 7712 S YALE AVE SUITE 100
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City | TULSA
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State | OK
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Zip | 74136-8332
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Country | US
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Telephone | 918-523-7226
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Fax | 918-523-7227
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Authorized Official
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Title or Position | OWNER
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Name | DEREK MICHAEL PRENTICE
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Credential |
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Telephone | 405-418-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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