| Addiction Management Llc | |
|
3015 E Skelly Dr Ste 103 Tulsa OK 74105-6344 | |
| (918) 509-5000 | |
| Not Available |
| Full Name | Addiction Management Llc |
|---|---|
| Speciality | General Practice |
| Location | 3015 E Skelly Dr Ste 103, Tulsa, Oklahoma |
| Authorized Official Name and Position | Gregory Berenato (OWNER) |
| Authorized Official Contact | 9185095000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Addiction Management Llc 3015 E Skelly Dr Ste 103 Tulsa OK 74105-6344 Ph: (918) 509-5000 | Addiction Management Llc 3015 E Skelly Dr Ste 103 Tulsa OK 74105-6344 Ph: (918) 509-5000 |
| NPI Number | 1154190692 |
|---|---|
| Provider Enumeration Date | 12/26/2023 |
| Last Update Date | 12/27/2023 |
| Medicare PECOS PAC ID | 9436502184 |
|---|---|
| Medicare Enrollment ID | O20240129003758 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154190692 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Ardeshir F Nia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902822802 PECOS PAC ID: 7911911177 Enrollment ID: I20070327000094 |
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