Provider Demographics
NPI:1417303801
Name:PARADIGM HORMONES TULSA, PLLC
Entity Type:Organization
Organization Name:PARADIGM HORMONES TULSA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSELLATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-703-7020
Mailing Address - Street 1:6316 E 102ND ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7061
Mailing Address - Country:US
Mailing Address - Phone:405-703-7020
Mailing Address - Fax:405-703-7021
Practice Address - Street 1:6316 E 102ND ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7061
Practice Address - Country:US
Practice Address - Phone:405-703-7020
Practice Address - Fax:405-703-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty