Provider Demographics
NPI:1720325715
Name:CAREATC
Entity Type:Organization
Organization Name:CAREATC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PRODUCT & DATA MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-779-7475
Mailing Address - Street 1:4500 S 129TH EAST AVE
Mailing Address - Street 2:SUITE 191
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-5801
Mailing Address - Country:US
Mailing Address - Phone:918-779-7900
Mailing Address - Fax:918-779-7425
Practice Address - Street 1:103 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SOLOMON
Practice Address - State:KS
Practice Address - Zip Code:67480-9760
Practice Address - Country:US
Practice Address - Phone:620-670-9008
Practice Address - Fax:877-549-7341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty