MEDICARE: CENTER FOR MEN'S HEALTH, INC.

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	207QA0505X	Adult Medicine Physician	4111	OK

General Provider Information

NPI Number	:	1336552710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR MEN'S HEALTH, INC.

Provider Business Mailing Address
First Line	:	5657 E 41ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-6010
Country	:	US
Telephone Number	:	918-622-2500
Fax Number	:	918-622-2502

Provider Business Practice Location Address
First Line	:	5657 E 41ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-6010
Country	:	US
Telephone Number	:	918-622-2500
Fax Number	:	918-622-2502

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM BLAINE PRICE JR.
Credential	:	D.O.
Telephone Number	:	918-645-5201

Provider Enumeration Date	:	06/03/2014
Last Update Date	:	10/29/2014

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