Provider Demographics
NPI:1811202955
Name:OKLAHOMA BRAIN TUMOR FOUNDATION
Entity Type:Organization
Organization Name:OKLAHOMA BRAIN TUMOR FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:S
Authorized Official - Last Name:THOMASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-843-4673
Mailing Address - Street 1:730 W WILSHIRE BLVD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7781
Mailing Address - Country:US
Mailing Address - Phone:405-843-4673
Mailing Address - Fax:
Practice Address - Street 1:730 W WILSHIRE BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7781
Practice Address - Country:US
Practice Address - Phone:405-843-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management