Provider Demographics
NPI:1346510476
Name:TULSA AMBULATORY PROCEDURE CENTER LLC
Entity Type:Organization
Organization Name:TULSA AMBULATORY PROCEDURE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-935-3200
Mailing Address - Street 1:2811 E 15TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5245
Mailing Address - Country:US
Mailing Address - Phone:918-935-3200
Mailing Address - Fax:918-935-3201
Practice Address - Street 1:2811 E 15TH ST STE 101
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5242
Practice Address - Country:US
Practice Address - Phone:918-935-3200
Practice Address - Fax:918-935-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200501680AMedicaid