Provider Demographics
NPI:1497965818
Name:HEART CARE OF TULSA, INC.
Entity Type:Organization
Organization Name:HEART CARE OF TULSA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:STOEVER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-582-3332
Mailing Address - Street 1:LOCKBOX DEPT 1910
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74182
Mailing Address - Country:US
Mailing Address - Phone:918-582-3332
Mailing Address - Fax:918-582-7003
Practice Address - Street 1:802 SOUTH JACKSON
Practice Address - Street 2:SUITE 225
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127
Practice Address - Country:US
Practice Address - Phone:918-582-3332
Practice Address - Fax:918-582-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1226207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK336285508004OtherBLUE CROSS BLUE SHIELD
OK100052530CMedicaid
OKE26928Medicare UPIN
OK336285508004OtherBLUE CROSS BLUE SHIELD