Provider Demographics
NPI:1851318497
Name:TULSA NEUROLOGY CLINIC INC.
Entity Type:Organization
Organization Name:TULSA NEUROLOGY CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-743-2882
Mailing Address - Street 1:7134 S YALE AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6372
Mailing Address - Country:US
Mailing Address - Phone:918-743-2882
Mailing Address - Fax:918-745-0323
Practice Address - Street 1:7134 S YALE AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6372
Practice Address - Country:US
Practice Address - Phone:918-743-2882
Practice Address - Fax:918-745-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100137280AMedicaid
OK1851318497OtherNPI
448664025001OtherBCBS
OKDP2445OtherRAILROAD MEDICARE
OK100137280AMedicaid
OKOKB5467Medicare PIN