Provider Demographics
NPI:1811940703
Name:SOUTH TULSA ULTRASOUND ASSOCIATES, L.L.C.
Entity type:Organization
Organization Name:SOUTH TULSA ULTRASOUND ASSOCIATES, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PRENTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-418-2200
Mailing Address - Street 1:7712 S YALE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8332
Mailing Address - Country:US
Mailing Address - Phone:918-523-7226
Mailing Address - Fax:918-523-7227
Practice Address - Street 1:7712 S YALE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8332
Practice Address - Country:US
Practice Address - Phone:918-523-7226
Practice Address - Fax:918-523-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology