MEDICARE: SNB 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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1497112205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SNB LLC

Provider Business Mailing Address
First Line	:	8010 S 101ST EAST AVE
Second Line	:	SUITE 200
City	:	TULSA
State	:	OK
Zip	:	74133-4562
Country	:	US
Telephone Number	:	918-872-9499
Fax Number	:	918-893-1294

Provider Business Practice Location Address
First Line	:	8010 S 101ST EAST AVE
Second Line	:	SUITE 200
City	:	TULSA
State	:	OK
Zip	:	74133-4562
Country	:	US
Telephone Number	:	918-872-9499
Fax Number	:	918-893-1294

Authorized Official
Title or Position	:	MANAGING MEMBER / CLINICAL DIRECTOR
Name	:	NAN A BERTONE
Credential	:	RN
Telephone Number	:	918-872-9499

Provider Enumeration Date	:	01/25/2016
Last Update Date	:	01/25/2016

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Directions to “SNB LLC ” Practice Location

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