| Gloryland Healthcare Services, Llc | |
|
1312 S Garnett Rd Tulsa OK 74128-1811 | |
| (918) 203-3164 | |
| (918) 203-3163 |
| Full Name | Gloryland Healthcare Services, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1312 S Garnett Rd, Tulsa, Oklahoma |
| Authorized Official Name and Position | Augustina Agadagba (OWNER) |
| Authorized Official Contact | 9188130511 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gloryland Healthcare Services, Llc 909 S Aster Ave Broken Arrow OK 74012-8832 Ph: (918) 813-0511 | Gloryland Healthcare Services, Llc 1312 S Garnett Rd Tulsa OK 74128-1811 Ph: (918) 203-3164 |
| NPI Number | 1811452907 |
|---|---|
| Provider Enumeration Date | 02/04/2019 |
| Last Update Date | 02/04/2019 |
| Medicare PECOS PAC ID | 5193067437 |
|---|---|
| Medicare Enrollment ID | O20190507000468 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811452907 | NPI | - | NPPES |
| 200498000A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Augustina Agadagba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205179561 PECOS PAC ID: 8527201557 Enrollment ID: I20130823000563 |
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