Provider Demographics
NPI:1336552710
Name:CENTER FOR MEN'S HEALTH, INC.
Entity Type:Organization
Organization Name:CENTER FOR MEN'S HEALTH, INC.
Other - Org Name:CENTER FOR MEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BLAINE
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:918-645-5201
Mailing Address - Street 1:5657 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6010
Mailing Address - Country:US
Mailing Address - Phone:918-622-2500
Mailing Address - Fax:918-622-2502
Practice Address - Street 1:5657 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6010
Practice Address - Country:US
Practice Address - Phone:918-622-2500
Practice Address - Fax:918-622-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4111207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty