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General NPI Number Information
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NPI Number | 1831595032
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Entity Type | Organization
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Legal Business Name | YOUR BEST LIFE LLC
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Dates
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Enumeration Date | 11/15/2014
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Last Update Date | 11/14/2015
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Provider Practice Location Address
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Address Line | 8010 S 101ST EAST AVE SUITE 200
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City | TULSA
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State | OK
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Zip | 74133-4562
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Country | US
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Telephone | 918-893-1440
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Fax | 918-893-1481
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Provider Business Mailing Address
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Address Line | 8010 S 101ST EAST AVE SUITE 200
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City | TULSA
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State | OK
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Zip | 74133-4562
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Country | US
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Telephone | 918-893-1440
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Fax | 918-893-1481
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Authorized Official
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Title or Position | OWNER
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Name | MR. FRED CARTER GLIDEWELL
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Credential |
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Telephone | 918-893-1440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 28027
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 28027
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License Number State | OK
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