Provider Demographics
NPI:1790722239
Name:NEUROLOGIC SERVICES OF OKLAHOMA LLC
Entity Type:Organization
Organization Name:NEUROLOGIC SERVICES OF OKLAHOMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-743-5552
Mailing Address - Street 1:PO BOX 59001
Mailing Address - Street 2:DEPT 4012
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74159-9001
Mailing Address - Country:US
Mailing Address - Phone:918-743-5552
Mailing Address - Fax:918-743-5553
Practice Address - Street 1:2424 E 21ST STREET
Practice Address - Street 2:STE 500
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1723
Practice Address - Country:US
Practice Address - Phone:918-743-5552
Practice Address - Fax:918-743-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
204R00000X
OK207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
611693000OtherDEPT OF LABOR
DE4687OtherRAILROAD MEDICARE
OK800522442Medicaid
611693000OtherDEPT OF LABOR
=========001OtherTRICARE
OK800522442Medicaid