Provider Demographics
NPI:1952692683
Name:J E BLOCK, M.D., FACP
Entity Type:Organization
Organization Name:J E BLOCK, M.D., FACP
Other - Org Name:ADVANCED MEDICAL WEIGHT LOSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGHTINGALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-591-3891
Mailing Address - Street 1:6048 S. SHERIDAN RD
Mailing Address - Street 2:STE B
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145
Mailing Address - Country:US
Mailing Address - Phone:918-591-3891
Mailing Address - Fax:918-895-7887
Practice Address - Street 1:6048 S. SHERIDAN RD
Practice Address - Street 2:STE B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145
Practice Address - Country:US
Practice Address - Phone:918-591-3891
Practice Address - Fax:918-895-7887
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATION HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100018500AMedicaid