Provider Demographics
NPI:1770800435
Name:SOUTH TULSA URGENT CARE LLC
Entity type:Organization
Organization Name:SOUTH TULSA URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-521-7131
Mailing Address - Street 1:7731 E 91ST ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6022
Mailing Address - Country:US
Mailing Address - Phone:918-519-5192
Mailing Address - Fax:
Practice Address - Street 1:7731 E 91ST ST
Practice Address - Street 2:SUITE C
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6022
Practice Address - Country:US
Practice Address - Phone:918-519-5192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty