Provider Demographics
NPI:1497112205
Name:SNB LLC
Entity Type:Organization
Organization Name:SNB LLC
Other - Org Name:PERSONAL HEALTH PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER / CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERTONE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-872-9499
Mailing Address - Street 1:8010 S 101ST EAST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4562
Mailing Address - Country:US
Mailing Address - Phone:918-872-9499
Mailing Address - Fax:918-893-1294
Practice Address - Street 1:8010 S 101ST EAST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4562
Practice Address - Country:US
Practice Address - Phone:918-872-9499
Practice Address - Fax:918-893-1294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service