| South Tulsa Community House | |
|
1208 E 58th St Tulsa OK 74105-8401 | |
| (918) 742-5597 | |
| (918) 742-4485 |
| Full Name | South Tulsa Community House |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1208 E 58th St, Tulsa, Oklahoma |
| Authorized Official Name and Position | Lanny R Endicott (PRESIDENT) |
| Authorized Official Contact | 9188301523 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Tulsa Community House 1208 E 58th St Tulsa OK 74105-8401 Ph: (918) 742-5597 | South Tulsa Community House 1208 E 58th St Tulsa OK 74105-8401 Ph: (918) 742-5597 |
| NPI Number | 1649549338 |
|---|---|
| Provider Enumeration Date | 12/25/2011 |
| Last Update Date | 12/25/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649549338 | NPI | - | NPPES |
| 1508994138 | Medicaid | OK | |
| 100723970B | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 296 (Oklahoma) | Primary |
| 251S00000X | Community/behavioral Health | 328 (Oklahoma) | Secondary |
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