Confortamini In Sacrificio Tuo Llc | |
2416 W 51st St Tulsa OK 74107-7700 | |
(713) 816-2522 | |
Not Available |
Full Name | Confortamini In Sacrificio Tuo Llc |
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Speciality | Internal Medicine |
Location | 2416 W 51st St, Tulsa, Oklahoma |
Authorized Official Name and Position | Ryan Reynolds (FOUNDER AND CEO) |
Authorized Official Contact | 7138162522 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Confortamini In Sacrificio Tuo Llc Po Box 701743 Tulsa OK 74170-1743 Ph: (713) 816-2522 | Confortamini In Sacrificio Tuo Llc 2416 W 51st St Tulsa OK 74107-7700 Ph: (713) 816-2522 |
NPI Number | 1508634692 |
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Provider Enumeration Date | 12/18/2023 |
Last Update Date | 08/13/2024 |
Medicare PECOS PAC ID | 2567904089 |
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Medicare Enrollment ID | O20240611003892 |
Identifier | Type | State | Issuer |
---|---|---|---|
1508634692 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Ryan Reynolds |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1114459278 PECOS PAC ID: 9537585989 Enrollment ID: I20220708000238 |
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