Memorial Health Group Llc | |
8131 S Memorial Dr Ste 100 Tulsa OK 74133-4348 | |
(918) 200-9944 | |
Not Available |
Full Name | Memorial Health Group Llc |
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Speciality | Family Medicine |
Location | 8131 S Memorial Dr Ste 100, Tulsa, Oklahoma |
Authorized Official Name and Position | Matthew Dyer (OWNER) |
Authorized Official Contact | 9188085629 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Memorial Health Group Llc 8131 S Memorial Dr Ste 100 Tulsa OK 74133-4348 Ph: (918) 200-9944 | Memorial Health Group Llc 8131 S Memorial Dr Ste 100 Tulsa OK 74133-4348 Ph: (918) 200-9944 |
NPI Number | 1619664307 |
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Provider Enumeration Date | 04/21/2023 |
Last Update Date | 08/03/2023 |
Medicare PECOS PAC ID | 4082073093 |
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Medicare Enrollment ID | O20230710001508 |
Identifier | Type | State | Issuer |
---|---|---|---|
1619664307 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Karen J Morgan Vanderlick |
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Provider Type | Practitioner - Anesthesiology |
Provider Identifiers | NPI Number: 1518162528 PECOS PAC ID: 3274699780 Enrollment ID: I20090309000460 |
Provider Name | Kenneth G Fulp |
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Provider Type | Practitioner - Anesthesiology |
Provider Identifiers | NPI Number: 1083668800 PECOS PAC ID: 7719977594 Enrollment ID: I20160613001166 |
Provider Name | Leslie Chan |
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Provider Type | Practitioner - Pain Management |
Provider Identifiers | NPI Number: 1912039850 PECOS PAC ID: 6002988037 Enrollment ID: I20160615000092 |
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