Provider Demographics
NPI:1538270954
Name:ALLERGY CLINIC OF TULSA, INC.
Entity type:Organization
Organization Name:ALLERGY CLINIC OF TULSA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-307-1613
Mailing Address - Street 1:9311 S MINGO RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5702
Mailing Address - Country:US
Mailing Address - Phone:918-307-1613
Mailing Address - Fax:918-307-2454
Practice Address - Street 1:9311 S MINGO RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5702
Practice Address - Country:US
Practice Address - Phone:918-307-1613
Practice Address - Fax:918-307-2454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6713610001OtherMEDICARE DMERC PTAN
OK6713610001OtherMEDICARE DMERC PTAN