Provider Demographics
NPI:1518186394
Name:MEDICAL & COSMETIC CENTER
Entity Type:Organization
Organization Name:MEDICAL & COSMETIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:
Authorized Official - Last Name:SNELLING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-749-3187
Mailing Address - Street 1:PO BOX 701272
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-1272
Mailing Address - Country:US
Mailing Address - Phone:918-749-3187
Mailing Address - Fax:918-749-3187
Practice Address - Street 1:4845 S SHERIDAN RD
Practice Address - Street 2:411
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5751
Practice Address - Country:US
Practice Address - Phone:918-749-3187
Practice Address - Fax:918-749-3187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371130Medicare UPIN