MEDICARE: GARDNER HEALTH & WELLNESS CENTER

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	261Q00000X	Clinic/Center	3552	OK

General Provider Information

NPI Number	:	1992106884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDNER HEALTH & WELLNESS CENTER

Provider Business Mailing Address
First Line	:	4120 E 51ST ST
Second Line	:	SUITE D
City	:	TULSA
State	:	OK
Zip	:	74135-3629
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 E 51ST ST
Second Line	:	SUITE D
City	:	TULSA
State	:	OK
Zip	:	74135-3629
Country	:	US
Telephone Number	:	918-663-6045
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BARRY GARDNER
Credential	:	DC
Telephone Number	:	918-663-6045

Provider Enumeration Date	:	09/10/2014
Last Update Date	:	09/10/2014

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