| Lifestyle Medical Center, Pllc | |
|
4505 S Harvard Ave Tulsa OK 74135-2905 | |
| (918) 747-5555 | |
| Not Available |
| Full Name | Lifestyle Medical Center, Pllc |
|---|---|
| Speciality | General Practice |
| Location | 4505 S Harvard Ave, Tulsa, Oklahoma |
| Authorized Official Name and Position | Gerry D Langston (PRESIDENT) |
| Authorized Official Contact | 9187475555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifestyle Medical Center, Pllc 4505 S Harvard Ave Tulsa OK 74135-2905 Ph: (918) 747-5555 | Lifestyle Medical Center, Pllc 4505 S Harvard Ave Tulsa OK 74135-2905 Ph: (918) 747-5555 |
| NPI Number | 1992214548 |
|---|---|
| Provider Enumeration Date | 09/27/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 2769746213 |
|---|---|
| Medicare Enrollment ID | O20180509000263 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992214548 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Gerry D Langston |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1578655502 PECOS PAC ID: 5698823771 Enrollment ID: I20090429000216 |
| Provider Name | Nickcole N Munoz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679932586 PECOS PAC ID: 3779877816 Enrollment ID: I20181205001585 |
| Provider Name | Brad A Finley |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1295952638 PECOS PAC ID: 8022000983 Enrollment ID: I20221019000326 |
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