Provider Demographics
NPI:1487859237
Name:SPILLARS MEDICAL, P.C.
Entity Type:Organization
Organization Name:SPILLARS MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODGER
Authorized Official - Middle Name:BRANNON
Authorized Official - Last Name:SPILLARS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-294-9865
Mailing Address - Street 1:8803 S 101ST EAST AVE
Mailing Address - Street 2:SUITE 295
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5726
Mailing Address - Country:US
Mailing Address - Phone:918-294-9865
Mailing Address - Fax:918-294-9866
Practice Address - Street 1:8803 S 101ST EAST AVE
Practice Address - Street 2:SUITE 295
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5726
Practice Address - Country:US
Practice Address - Phone:918-294-9865
Practice Address - Fax:918-294-9866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100132160CMedicaid
OK100132160CMedicaid