Provider Demographics
NPI:1942376454
Name:ALTERNATIVE MEDICINE OF TULSA INC
Entity Type:Organization
Organization Name:ALTERNATIVE MEDICINE OF TULSA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:SHEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-660-0031
Mailing Address - Street 1:4845 S SHERIDAN RD STE 509
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-5719
Mailing Address - Country:US
Mailing Address - Phone:918-660-0031
Mailing Address - Fax:918-660-0056
Practice Address - Street 1:4845 S SHERIDAN RD STE 509
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5719
Practice Address - Country:US
Practice Address - Phone:918-660-0031
Practice Address - Fax:918-660-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1027261OtherNCCPA
OK10210OtherOK ST BOARD OF MED LIC
OK408OtherOK STATE BRD OF MED LIC
OK408OtherOK STATE BRD OF MED LIC
OK408OtherOK STATE BRD OF MED LIC