Provider Demographics
NPI:1982926994
Name:OKLAHOMA VEIN CENTER
Entity Type:Organization
Organization Name:OKLAHOMA VEIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-392-0880
Mailing Address - Street 1:7322 E 91ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6016
Mailing Address - Country:US
Mailing Address - Phone:918-392-0880
Mailing Address - Fax:918-392-0990
Practice Address - Street 1:9906 RIVERSIDE PKWY
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7409
Practice Address - Country:US
Practice Address - Phone:918-298-8080
Practice Address - Fax:918-528-3841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty