MEDICARE: TULSA NEURO TESTING, PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1114326451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TULSA NEURO TESTING, PLC

Provider Business Mailing Address
First Line	:	PO BOX 21568
Second Line	:	DEPT 323
City	:	TULSA
State	:	OK
Zip	:	74121-1568
Country	:	US
Telephone Number	:	214-675-0905
Fax Number	:	214-317-4888

Provider Business Practice Location Address
First Line	:	9521 RIVERSIDE PKWY
Second Line	:	SUIYE B, #338
City	:	TULSA
State	:	OK
Zip	:	74137-7418
Country	:	US
Telephone Number	:	214-675-0905
Fax Number	:	214-317-4888

Authorized Official
Title or Position	:	OWNER
Name	:	JAYEN PATEL
Credential	:
Telephone Number	:	214-675-0905

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	08/21/2014

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