Provider Demographics
NPI:1194396721
Name:OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE, LLC
Entity Type:Organization
Organization Name:OKLAHOMA CANCER SPECIALISTS AND RESEARCH INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGD CARE & CRED COOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DREESEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-499-2141
Mailing Address - Street 1:12697 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-6236
Mailing Address - Country:US
Mailing Address - Phone:918-499-2141
Mailing Address - Fax:918-499-2141
Practice Address - Street 1:1819 E 19TH ST FL 5
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5407
Practice Address - Country:US
Practice Address - Phone:918-505-3200
Practice Address - Fax:918-505-3225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200627090AMedicaid