Provider Demographics
NPI:1861939126
Name:SMART SINUS OK, LLC
Entity type:Organization
Organization Name:SMART SINUS OK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIR
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-278-1885
Mailing Address - Street 1:7322 E 91ST ST
Mailing Address - Street 2:TULSA SURGICAL ART
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6016
Mailing Address - Country:US
Mailing Address - Phone:918-392-0880
Mailing Address - Fax:918-697-4134
Practice Address - Street 1:7322 E 91ST ST
Practice Address - Street 2:TULSA SURGICAL ART
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6016
Practice Address - Country:US
Practice Address - Phone:918-392-0880
Practice Address - Fax:918-697-4134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty