Provider Demographics
NPI:1952436453
Name:J. WADE M. D. - NEUROLOGY, P.C.
Entity Type:Organization
Organization Name:J. WADE M. D. - NEUROLOGY, P.C.
Other - Org Name:J. WADE M. D. - NEUROLOGY, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:B
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:918-587-5100
Mailing Address - Street 1:PO BOX 2169
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74101-2169
Mailing Address - Country:US
Mailing Address - Phone:918-587-5100
Mailing Address - Fax:
Practice Address - Street 1:2526 W EDISON ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-6128
Practice Address - Country:US
Practice Address - Phone:918-587-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK145982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100250220BMedicaid
OKD35374Medicare UPIN
OK3374443380PMedicare ID - Type Unspecified