MEDICARE: ALTERNATIVE MEDICINE OF TULSA INC

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	207Q00000X	Family Medicine Physician	10210	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1027261	OTHER	OK	NCCPA
2	10210	OTHER	OK	OK ST BOARD OF MED LIC
3	408	OTHER	OK	OK STATE BRD OF MED LIC

General Provider Information

NPI Number	:	1942376454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTERNATIVE MEDICINE OF TULSA INC

Provider Business Mailing Address
First Line	:	4845 S SHERIDAN RD STE 509
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-5719
Country	:	US
Telephone Number	:	918-660-0031
Fax Number	:	918-660-0056

Provider Business Practice Location Address
First Line	:	4845 S SHERIDAN RD STE 509
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74145-5719
Country	:	US
Telephone Number	:	918-660-0031
Fax Number	:	918-660-0056

Authorized Official
Title or Position	:	VICE PRESIDENT OWNER
Name	:	MS. TONYA DENISE SHEHAN
Credential	:	RN
Telephone Number	:	918-660-0031

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	08/22/2020

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