Provider Demographics
NPI:1457004806
Name:NORTHEAST OKLAHOMA HAND & UPPER EXTREMITY SURGERY PLLC
Entity Type:Organization
Organization Name:NORTHEAST OKLAHOMA HAND & UPPER EXTREMITY SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-304-9108
Mailing Address - Street 1:8110 S YALE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2210
Mailing Address - Country:US
Mailing Address - Phone:713-304-9108
Mailing Address - Fax:
Practice Address - Street 1:8110 S YALE AVE STE 200
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2210
Practice Address - Country:US
Practice Address - Phone:713-304-9108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty