| East Tulsa Family Health Center | |
|
11511 E 21st St Tulsa OK 74129-1815 | |
| (918) 295-6185 | |
| (918) 439-4205 |
| Full Name | East Tulsa Family Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 11511 E 21st St, Tulsa, Oklahoma |
| Authorized Official Name and Position | Saunya Moore (CFO) |
| Authorized Official Contact | 9182956107 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Tulsa Family Health Center 1334 N Lansing Ave Tulsa OK 74106-5907 Ph: (918) 587-2171 | East Tulsa Family Health Center 11511 E 21st St Tulsa OK 74129-1815 Ph: (918) 295-6185 |
| NPI Number | 1205822830 |
|---|---|
| Provider Enumeration Date | 09/20/2005 |
| Last Update Date | 07/24/2019 |
| Medicare PECOS PAC ID | 1951297621 |
|---|---|
| Medicare Enrollment ID | O20111213000780 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205822830 | NPI | - | NPPES |
| 100768880F | Medicaid | OK | |
| 1205822830 | Other | OK | NPI |
| WCDPG | Other | OK | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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