Provider Demographics
NPI:1003149741
Name:TULSA SPECIALTY HOSPITAL LLC
Entity Type:Organization
Organization Name:TULSA SPECIALTY HOSPITAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-947-5557
Mailing Address - Street 1:4400 WILL ROGERS PKWY
Mailing Address - Street 2:STE 105
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-1837
Mailing Address - Country:US
Mailing Address - Phone:405-947-5557
Mailing Address - Fax:405-948-6507
Practice Address - Street 1:3219 S 79TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1343
Practice Address - Country:US
Practice Address - Phone:918-663-8183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty