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NPI Code Detail

MEDICARE: TERRAIN MEDICAL LLC

MEDICARE: TERRAIN MEDICAL 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
1261QM0855XAdolescent and Children Mental Health Clinic/Center
2261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1932944063
Entity Type Code : Organization
Provider Name (Legal Business Name) : TERRAIN MEDICAL LLC
Provider Business Mailing Address
First Line : 2106 S CINCINNATI AVE APT C
Second Line :
City : TULSA
State : OK
Zip : 74114-1253
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2106 S CINCINNATI AVE APT C
Second Line :
City : TULSA
State : OK
Zip : 74114-1253
Country : US
Telephone Number : 580-656-3188
Fax Number :
Authorized Official
Title or Position : CEO
Name : ZACHARY MCDONALD
Credential : MD
Telephone Number : 580-656-3188
Provider Enumeration Date : 06/29/2024
Last Update Date : 06/29/2024

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Directions to “TERRAIN MEDICAL LLC ” Practice Location

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