Provider Demographics
NPI:1598198780
Name:PRIMARY CARE PHYSICIANS OF TULSA REGION PC
Entity Type:Organization
Organization Name:PRIMARY CARE PHYSICIANS OF TULSA REGION PC
Other - Org Name:WELLQUEST MEDICAL & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:RIPPY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-361-4192
Mailing Address - Street 1:3400 SE MACY RD STE 18
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7844
Mailing Address - Country:US
Mailing Address - Phone:479-845-4476
Mailing Address - Fax:479-286-0061
Practice Address - Street 1:8005 E 106TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6600
Practice Address - Country:US
Practice Address - Phone:918-361-4192
Practice Address - Fax:479-286-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization