Provider Demographics
NPI:1659008621
Name:CRAFT CONCIERGE MEDICAL LLC
Entity Type:Organization
Organization Name:CRAFT CONCIERGE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-203-6800
Mailing Address - Street 1:5711 E 71ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6655
Mailing Address - Country:US
Mailing Address - Phone:918-203-6800
Mailing Address - Fax:918-203-6801
Practice Address - Street 1:5711 E 71ST ST STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6655
Practice Address - Country:US
Practice Address - Phone:918-203-6800
Practice Address - Fax:918-203-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care