Provider Demographics
NPI:1831595032
Name:YOUR BEST LIFE LLC
Entity type:Organization
Organization Name:YOUR BEST LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:GLIDEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-893-1440
Mailing Address - Street 1:8010 S 101ST EAST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4562
Mailing Address - Country:US
Mailing Address - Phone:918-893-1440
Mailing Address - Fax:918-893-1481
Practice Address - Street 1:8010 S 101ST EAST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4562
Practice Address - Country:US
Practice Address - Phone:918-893-1440
Practice Address - Fax:918-893-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-15
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28027261QM2500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK102905Medicare PIN