MEDICARE: TULSA ACCIDENT CARE CENTER LLC

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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1194669200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TULSA ACCIDENT CARE CENTER LLC

Provider Business Mailing Address
First Line	:	514 PLAZA CT
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-7915
Country	:	US
Telephone Number	:	918-888-8080
Fax Number	:	918-888-8181

Provider Business Practice Location Address
First Line	:	514 PLAZA CT
Second Line	:
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-7915
Country	:	US
Telephone Number	:	918-888-8080
Fax Number	:	918-888-8181

Authorized Official
Title or Position	:	OWNER
Name	:	TREY MARLER
Credential	:
Telephone Number	:	918-888-8080

Provider Enumeration Date	:	04/17/2026
Last Update Date	:	04/17/2026

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