Provider Demographics
NPI:1801355813
Name:TULSA CARDIOVASCULAR CENTER OF EXCELLENCE, L.L.C
Entity type:Organization
Organization Name:TULSA CARDIOVASCULAR CENTER OF EXCELLENCE, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:COMSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-943-5303
Mailing Address - Street 1:11912 S. NORWOOD AVE #205
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137
Mailing Address - Country:US
Mailing Address - Phone:918-943-5303
Mailing Address - Fax:918-943-5302
Practice Address - Street 1:11912 S NORWOOD AVE STE 105
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-5509
Practice Address - Country:US
Practice Address - Phone:918-943-5303
Practice Address - Fax:918-943-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty