Provider Demographics
NPI:1518028125
Name:EAR NOSE & THROAT CLINIC OF TULSA, INC
Entity Type:Organization
Organization Name:EAR NOSE & THROAT CLINIC OF TULSA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:C
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:WORRALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-744-0228
Mailing Address - Street 1:4444 S HARVARD AVE
Mailing Address - Street 2:#100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2634
Mailing Address - Country:US
Mailing Address - Phone:918-744-0228
Mailing Address - Fax:918-744-6613
Practice Address - Street 1:4444 S HARVARD AVE
Practice Address - Street 2:#100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2634
Practice Address - Country:US
Practice Address - Phone:918-744-0228
Practice Address - Fax:918-744-6613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty