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General NPI Number Information
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NPI Number | 1841695806
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Entity Type | Organization
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Legal Business Name | THE PETTY MANAGEMENT GROUP, LLC
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Dates
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Enumeration Date | 11/01/2014
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Last Update Date | 11/01/2014
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Provider Practice Location Address
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Address Line | 136 N GREENWOOD AVE
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City | TULSA
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State | OK
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Zip | 74120-1409
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Country | US
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Telephone | 918-592-9000
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Fax | 918-592-0049
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Provider Business Mailing Address
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Address Line | 136 N GREENWOOD AVE
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City | TULSA
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State | OK
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Zip | 74120-1409
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MECHELLE PETTY
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Credential |
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Telephone | 918-592-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC8039
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License Number State | OK
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