Provider Demographics
NPI:1437338480
Name:TULSA NEUROSPINE, PLLC
Entity Type:Organization
Organization Name:TULSA NEUROSPINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-481-4965
Mailing Address - Street 1:6565 SOUTH YALE
Mailing Address - Street 2:SUITE 709
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8308
Mailing Address - Country:US
Mailing Address - Phone:918-481-4965
Mailing Address - Fax:918-481-4996
Practice Address - Street 1:6565 SOUTH YALE
Practice Address - Street 2:SUITE 709
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8308
Practice Address - Country:US
Practice Address - Phone:918-481-4965
Practice Address - Fax:918-481-4996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK442542694004OtherBLUE CROSS BLUE SHIELD
OK900522063Medicare PIN