| Northside Family Practice Pllc | |
|
3606 N Cincinnati Ave Tulsa OK 74106-1536 | |
| (918) 794-3536 | |
| Not Available |
| Full Name | Northside Family Practice Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3606 N Cincinnati Ave, Tulsa, Oklahoma |
| Authorized Official Name and Position | Prakash George (CFO) |
| Authorized Official Contact | 9187049408 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northside Family Practice Pllc 3606 N Cincinnati Ave Tulsa OK 74106-1536 Ph: (918) 794-3536 | Northside Family Practice Pllc 3606 N Cincinnati Ave Tulsa OK 74106-1536 Ph: (918) 794-3536 |
| NPI Number | 1205103231 |
|---|---|
| Provider Enumeration Date | 11/18/2011 |
| Last Update Date | 03/07/2012 |
| Medicare PECOS PAC ID | 7214195874 |
|---|---|
| Medicare Enrollment ID | O20120228000682 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205103231 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Ulysses Bowler |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1942290788 PECOS PAC ID: 2163447731 Enrollment ID: I20051012000876 |
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