Provider Demographics
NPI:1083774236
Name:TULSA COLON AND RECTAL SURGERY INC
Entity Type:Organization
Organization Name:TULSA COLON AND RECTAL SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:FENGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-294-4788
Mailing Address - Street 1:4735 E 91ST
Mailing Address - Street 2:200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2804
Mailing Address - Country:US
Mailing Address - Phone:918-794-4788
Mailing Address - Fax:918-794-4789
Practice Address - Street 1:4735 E 91ST
Practice Address - Street 2:200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2804
Practice Address - Country:US
Practice Address - Phone:918-794-4788
Practice Address - Fax:918-794-4789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C54766OtherUNITED HEALTHCARE RR MC