Provider Demographics
NPI:1659560563
Name:RT MEDICAL
Entity Type:Organization
Organization Name:RT MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:TIPSWORD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-722-1110
Mailing Address - Street 1:2514 NORTH MERIDIAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-1035
Mailing Address - Country:US
Mailing Address - Phone:405-722-1110
Mailing Address - Fax:405-721-8263
Practice Address - Street 1:2514 NORTH MERIDIAN AVENUE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-1035
Practice Address - Country:US
Practice Address - Phone:405-722-1110
Practice Address - Fax:405-721-8263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200032500AMedicaid
OK20522097Medicare PIN
OK200032500AMedicaid