| |
1120 S Utica Ave Tulsa OK 74104-4012 | |
(918) 579-1000 | |
Not Available |
Full Name | |
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Speciality | Internal Medicine |
Location | 1120 S Utica Ave, Tulsa, Oklahoma |
Authorized Official Name and Position | Boykin Robinson (CEO) |
Authorized Official Contact | 4045008147 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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400 Galleria Pkwy Se Ste 1755 Atlanta GA 30339-5934 Ph: (404) 500-8147 | 1120 S Utica Ave Tulsa OK 74104-4012 Ph: (918) 579-1000 |
NPI Number | 1497417067 |
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Provider Enumeration Date | 10/11/2021 |
Last Update Date | 12/06/2023 |
Medicare PECOS PAC ID | 4183011026 |
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Medicare Enrollment ID | O20220425001394 |
Identifier | Type | State | Issuer |
---|---|---|---|
1497417067 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
Provider Name | Gerald G Reed |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1093779993 PECOS PAC ID: 9638105901 Enrollment ID: I20050831000510 |
Provider Name | Vallory J Tramonte |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1790826485 PECOS PAC ID: 5991801540 Enrollment ID: I20070428000071 |
Provider Name | Stanley W Tallon |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1114354727 PECOS PAC ID: 6204067523 Enrollment ID: I20140328001506 |
Provider Name | John Gemma |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1750791760 PECOS PAC ID: 4789954769 Enrollment ID: I20170725000354 |
Provider Name | Daniel Scheurich |
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Provider Type | Practitioner - Hospitalist |
Provider Identifiers | NPI Number: 1659396539 PECOS PAC ID: 7810082724 Enrollment ID: I20191015002814 |
Provider Name | Queen Erue |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1659955771 PECOS PAC ID: 1759780554 Enrollment ID: I20210527002032 |
Provider Name | Asad Khan Mohmand |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1336349182 PECOS PAC ID: 2668543745 Enrollment ID: I20220427002294 |
Provider Name | Aria Williams |
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Provider Type | Practitioner - Infectious Disease |
Provider Identifiers | NPI Number: 1154566412 PECOS PAC ID: 7517112683 Enrollment ID: I20220518002553 |
Provider Name | Lysenia Mojica |
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Provider Type | Practitioner - Infectious Disease |
Provider Identifiers | NPI Number: 1215256649 PECOS PAC ID: 0446577399 Enrollment ID: I20220526001122 |
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