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NPI Code Detail

MEDICARE: MEDWISE LLC

MEDICARE: MEDWISE 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
1261QU0200XUrgent Care Clinic/Center

General Provider Information

NPI Number : 1538981204
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDWISE LLC
Provider Business Mailing Address
First Line : 12902 E 51ST ST
Second Line :
City : TULSA
State : OK
Zip : 74134-6712
Country : US
Telephone Number : 918-994-3476
Fax Number :
Provider Business Practice Location Address
First Line : 6336 E ADMIRAL PL
Second Line :
City : TULSA
State : OK
Zip : 74115
Country : US
Telephone Number : 918-727-2831
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DENNIS SIDNEY BLACKSTAD
Credential : MD
Telephone Number : 918-605-6582
Provider Enumeration Date : 10/24/2024
Last Update Date : 03/19/2025

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Directions to “MEDWISE LLC ” Practice Location

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