Provider Demographics
NPI:1942247788
Name:NEUROSURGICAL SPECIALISTS OF TULSA INC
Entity Type:Organization
Organization Name:NEUROSURGICAL SPECIALISTS OF TULSA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAROUK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-583-5131
Mailing Address - Street 1:2128 S ATLANTA PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1755
Mailing Address - Country:US
Mailing Address - Phone:918-583-5131
Mailing Address - Fax:918-592-0670
Practice Address - Street 1:2128 S ATLANTA PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1755
Practice Address - Country:US
Practice Address - Phone:918-583-5131
Practice Address - Fax:918-592-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100742510AMedicaid
OK175215700OtherDEPARTMENT OF LABOR
OKCJ9784Medicare PIN
OK4363700001Medicare PIN
OK100742510AMedicaid