MEDICARE: BLUE SPARROW WELLNESS, 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1629724026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE SPARROW WELLNESS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 691720
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74169-1720
Country	:	US
Telephone Number	:	918-895-9550
Fax Number	:

Provider Business Practice Location Address
First Line	:	4734 S 166TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74134-7255
Country	:	US
Telephone Number	:	918-895-9550
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. CHARLES DAVID MURR
Credential	:	MD
Telephone Number	:	918-770-2698

Provider Enumeration Date	:	02/23/2022
Last Update Date	:	02/23/2022

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Directions to “BLUE SPARROW WELLNESS, LLC ” Practice Location

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