Provider Demographics
NPI:1073658092
Name:FAMILY MEDICAL SERVICES OF TULSA P C
Entity Type:Organization
Organization Name:FAMILY MEDICAL SERVICES OF TULSA P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GREWE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-749-3533
Mailing Address - Street 1:3316 E 21ST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1967
Mailing Address - Country:US
Mailing Address - Phone:918-749-3533
Mailing Address - Fax:918-749-9789
Practice Address - Street 1:3316 E 21ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1967
Practice Address - Country:US
Practice Address - Phone:918-749-3533
Practice Address - Fax:918-749-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty