Provider Demographics
NPI:1528375995
Name:EM MADD, LLC
Entity Type:Organization
Organization Name:EM MADD, LLC
Other - Org Name:BRIAN WORLEY, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-994-4130
Mailing Address - Street 1:8803 S 101ST EAST AVE
Mailing Address - Street 2:SUITE 383
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5726
Mailing Address - Country:US
Mailing Address - Phone:918-994-4130
Mailing Address - Fax:918-994-4132
Practice Address - Street 1:8803 S 101ST EAST AVE
Practice Address - Street 2:SUITE 383
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5726
Practice Address - Country:US
Practice Address - Phone:918-994-4130
Practice Address - Fax:918-994-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100069180AMedicaid
OK200309830AMedicaid
OK200309830AMedicaid