Provider Demographics
NPI:1215003314
Name:TNI-KSO PC
Entity Type:Organization
Organization Name:TNI-KSO PC
Other - Org Name:NEPHROLOGY SPECIALISTS OF OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-481-2763
Mailing Address - Street 1:6465 S YALE AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7823
Mailing Address - Country:US
Mailing Address - Phone:918-481-2763
Mailing Address - Fax:918-481-2775
Practice Address - Street 1:6465 S YALE AVE
Practice Address - Street 2:SUITE 507
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7823
Practice Address - Country:US
Practice Address - Phone:918-481-2763
Practice Address - Fax:918-481-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty