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General NPI Number Information
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NPI Number | 1871303313
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Entity Type | Organization
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Legal Business Name | NR SOUTH TULSA LLC
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 9101 S TOLEDO AVE STE A
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City | TULSA
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State | OK
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Zip | 74137-2719
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Country | US
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Telephone | 918-398-0802
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Fax | 405-669-3517
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Provider Business Mailing Address
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Address Line | 3705 NW 63RD ST STE 200
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-1937
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Country | US
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Telephone | 405-953-7221
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Fax | 405-669-3517
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Authorized Official
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Title or Position | CEO/OWNER
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Name | TIMOTHY C BALES
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Credential |
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Telephone | 405-953-7221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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