Provider Demographics
NPI:1356219117
Name:TANKAM ENTERPRISE LLC
Entity type:Organization
Organization Name:TANKAM ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:N
Authorized Official - Last Name:TANKAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:572-212-6107
Mailing Address - Street 1:201 ROBERT S KERR AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-4203
Mailing Address - Country:US
Mailing Address - Phone:572-212-6107
Mailing Address - Fax:
Practice Address - Street 1:6208 NW 177TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012
Practice Address - Country:US
Practice Address - Phone:572-212-6107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care