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NPI Code Detail

MEDICARE: TULSA PODIATRY CLINICS LLC

MEDICARE: TULSA PODIATRY CLINICS 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
1213E00000XPodiatrist

General Provider Information

NPI Number : 1619475696
Entity Type Code : Organization
Provider Name (Legal Business Name) : TULSA PODIATRY CLINICS LLC
Provider Business Mailing Address
First Line : PO BOX 5231
Second Line :
City : EDMOND
State : OK
Zip : 73083-5231
Country : US
Telephone Number : 405-816-6266
Fax Number : 405-285-8921
Provider Business Practice Location Address
First Line : 416 W 15TH ST STE 500C
Second Line :
City : EDMOND
State : OK
Zip : 73013-3672
Country : US
Telephone Number : 405-471-6190
Fax Number : 405-285-8900
Authorized Official
Title or Position : CEO
Name : MR. CHAD E HUFFMYER
Credential :
Telephone Number : 405-816-6266
Provider Enumeration Date : 01/25/2018
Last Update Date : 01/25/2018

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Directions to “TULSA PODIATRY CLINICS LLC ” Practice Location

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