Provider Demographics
NPI:1952898751
Name:EMERGE MEDICAL & WELL SPA
Entity Type:Organization
Organization Name:EMERGE MEDICAL & WELL SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPA DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TARYN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-392-8606
Mailing Address - Street 1:9124 S SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5332
Mailing Address - Country:US
Mailing Address - Phone:918-392-8606
Mailing Address - Fax:918-392-8607
Practice Address - Street 1:9124 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5332
Practice Address - Country:US
Practice Address - Phone:918-392-8606
Practice Address - Fax:918-392-8607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK110604261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty