Provider Demographics
NPI:1629724026
Name:BLUE SPARROW WELLNESS, LLC
Entity Type:Organization
Organization Name:BLUE SPARROW WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MURR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-770-2698
Mailing Address - Street 1:PO BOX 691720
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74169-1720
Mailing Address - Country:US
Mailing Address - Phone:918-895-9550
Mailing Address - Fax:
Practice Address - Street 1:4734 S 166TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-7255
Practice Address - Country:US
Practice Address - Phone:918-895-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty