Provider Demographics
NPI:1598710436
Name:TULSA CT LLC
Entity Type:Organization
Organization Name:TULSA CT LLC
Other - Org Name:CT OF TULSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WINERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-492-6440
Mailing Address - Street 1:PO BOX 22155
Mailing Address - Street 2:DEPT 1200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-2155
Mailing Address - Country:US
Mailing Address - Phone:918-745-2299
Mailing Address - Fax:918-745-2313
Practice Address - Street 1:1855 E 15TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4610
Practice Address - Country:US
Practice Address - Phone:918-742-8010
Practice Address - Fax:918-742-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200051770AMedicaid
OK200522051Medicare ID - Type Unspecified