| Phillip A Black Llc | |
|
4815 S Harvard Ave Ste 428 Tulsa OK 74135-3068 | |
| (918) 605-8614 | |
| Not Available |
| Full Name | Phillip A Black Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4815 S Harvard Ave Ste 428, Tulsa, Oklahoma |
| Authorized Official Name and Position | Phillip A Black (OWNER) |
| Authorized Official Contact | 9186058614 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Phillip A Black Llc 500 S Sweet Gum Ave Broken Arrow OK 74012-4543 Ph: (918) 605-8614 | Phillip A Black Llc 4815 S Harvard Ave Ste 428 Tulsa OK 74135-3068 Ph: (918) 605-8614 |
| NPI Number | 1851751135 |
|---|---|
| Provider Enumeration Date | 03/01/2016 |
| Last Update Date | 03/01/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851751135 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2649 (Oklahoma) | Primary |
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