Provider Demographics
NPI:1861110819
Name:REMEDY HEALTH DIRECT PRIMARY CARE
Entity type:Organization
Organization Name:REMEDY HEALTH DIRECT PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:918-937-7705
Mailing Address - Street 1:3345 S HARVARD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-1809
Mailing Address - Country:US
Mailing Address - Phone:918-262-4502
Mailing Address - Fax:918-238-6630
Practice Address - Street 1:3345 S HARVARD AVE STE 201
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-1809
Practice Address - Country:US
Practice Address - Phone:918-262-4502
Practice Address - Fax:918-238-6630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1548383003Medicaid
OK1659539401Medicaid