Provider Demographics
NPI:1659566370
Name:TULSA NEUROLOGY & HEADACHE CLINIC, INC
Entity Type:Organization
Organization Name:TULSA NEUROLOGY & HEADACHE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHASHI
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-587-5534
Mailing Address - Street 1:PO BOX 21228
Mailing Address - Street 2:DEPT 144
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74121-1228
Mailing Address - Country:US
Mailing Address - Phone:187-774-2631
Mailing Address - Fax:281-812-2002
Practice Address - Street 1:1145 S UTICA AVE
Practice Address - Street 2:SUITE 520
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4000
Practice Address - Country:US
Practice Address - Phone:918-587-5534
Practice Address - Fax:918-587-5610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13418174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========001OtherBLUE CROSS BLUE SHIELD
OK=========002OtherBLUE CROSS BLUE SHIELD
OKD34841Medicare UPIN