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
State | License ID | Taxonomies |
---|---|---|
OK | OK110604 | 261QM1300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |