Provider Demographics
NPI:1619475696
Name:TULSA PODIATRY CLINICS LLC
Entity Type:Organization
Organization Name:TULSA PODIATRY CLINICS LLC
Other - Org Name:HEALTHMARK PHYSICIANS NETWORK LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUFFMYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-816-6266
Mailing Address - Street 1:PO BOX 5231
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-5231
Mailing Address - Country:US
Mailing Address - Phone:405-816-6266
Mailing Address - Fax:405-285-8921
Practice Address - Street 1:416 W 15TH ST STE 500C
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3672
Practice Address - Country:US
Practice Address - Phone:405-471-6190
Practice Address - Fax:405-285-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty