| Inter Id Inc | |
|
6565 S Yale Ave Ste 812 Tulsa OK 74136-8354 | |
| (918) 494-9486 | |
| (918) 494-9480 |
| Full Name | Inter Id Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 6565 S Yale Ave, Tulsa, Oklahoma |
| Authorized Official Name and Position | Mark Dillier Rowland (PRESIDENT) |
| Authorized Official Contact | 9184949486 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Inter Id Inc 6565 S Yale Ave Ste 812 Tulsa OK 74136-8354 Ph: (918) 494-9486 | Inter Id Inc 6565 S Yale Ave Ste 812 Tulsa OK 74136-8354 Ph: (918) 494-9486 |
| NPI Number | 1104803956 |
|---|---|
| Provider Enumeration Date | 12/22/2005 |
| Last Update Date | 12/17/2012 |
| Medicare PECOS PAC ID | 9830169143 |
|---|---|
| Medicare Enrollment ID | O20040726001219 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104803956 | NPI | - | NPPES |
| 100737010A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | William J Lewis |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1063496859 PECOS PAC ID: 6709856024 Enrollment ID: I20101007000499 |
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