Provider Demographics
NPI:1508493784
Name:SQUAREONE COMPASSION INC
Entity Type:Organization
Organization Name:SQUAREONE COMPASSION INC
Other - Org Name:SQUAREONE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:RILEY
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-521-4185
Mailing Address - Street 1:5323 SOUTH 65TH WEST AVENUE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107
Mailing Address - Country:US
Mailing Address - Phone:918-340-5024
Mailing Address - Fax:
Practice Address - Street 1:5323 SOUTH 65TH WEST AVENUE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74107
Practice Address - Country:US
Practice Address - Phone:918-340-5024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SQUAREONE COMPASSION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-26
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care