| Tulsa Vein Institute Pllc | |
|
6901 S Yorktown Ave Tulsa OK 74136-3986 | |
| (918) 706-2161 | |
| (918) 701-2021 |
| Full Name | Tulsa Vein Institute Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 6901 S Yorktown Ave, Tulsa, Oklahoma |
| Authorized Official Name and Position | Glenn Davin Haraway (PRACTITIONER) |
| Authorized Official Contact | 9187062161 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tulsa Vein Institute Pllc 6901 S Yorktown Ave Tulsa OK 74136-3986 Ph: (918) 706-2161 | Tulsa Vein Institute Pllc 6901 S Yorktown Ave Tulsa OK 74136-3986 Ph: (918) 706-2161 |
| NPI Number | 1154714673 |
|---|---|
| Provider Enumeration Date | 03/09/2015 |
| Last Update Date | 10/06/2022 |
| Medicare PECOS PAC ID | 4284953969 |
|---|---|
| Medicare Enrollment ID | O20150430001045 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154714673 | NPI | - | NPPES |
| 405679 | Other | OK | MEDICARE PTAN |
| 200582270A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 3263 (Oklahoma) | Primary |
| Provider Name | Glenn D Haraway |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679679062 PECOS PAC ID: 1456454156 Enrollment ID: I20111230000488 |
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