MEDICARE: CONCIERGE CARDIOLOGY OF OKLAHOMA

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	207RC0000X	Cardiovascular Disease Physician
2	363LA2100X	Acute Care Nurse Practitioner

General Provider Information

NPI Number	:	1790542728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCIERGE CARDIOLOGY OF OKLAHOMA

Provider Business Mailing Address
First Line	:	7403 W 39TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74107-4865
Country	:	US
Telephone Number	:	918-527-0561
Fax Number	:

Provider Business Practice Location Address
First Line	:	7403 W 39TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74107-4865
Country	:	US
Telephone Number	:	918-527-0561
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GINI ANN RENFROW
Credential	:	APRN-CNP
Telephone Number	:	918-527-0561

Provider Enumeration Date	:	03/05/2024
Last Update Date	:	03/05/2024

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