Provider Demographics
NPI:1356811764
Name:REGIONAL BRAIN INSTITUTE PLLC
Entity type:Organization
Organization Name:REGIONAL BRAIN INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-595-4800
Mailing Address - Street 1:6120 S YALE AVE STE 1210
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-4234
Mailing Address - Country:US
Mailing Address - Phone:918-888-5211
Mailing Address - Fax:918-888-5270
Practice Address - Street 1:6120 S YALE AVE STE 1210
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-4234
Practice Address - Country:US
Practice Address - Phone:918-888-5211
Practice Address - Fax:918-888-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-28
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty