Provider Demographics
NPI:1871745802
Name:TULSA PEDIATRIC URGENT CARE
Entity type:Organization
Organization Name:TULSA PEDIATRIC URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-625-6313
Mailing Address - Street 1:6528 E. 101ST STREET PMB#431
Mailing Address - Street 2:SUITE D1
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133
Mailing Address - Country:US
Mailing Address - Phone:918-895-7808
Mailing Address - Fax:918-895-7807
Practice Address - Street 1:7717 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6053
Practice Address - Country:US
Practice Address - Phone:918-895-7808
Practice Address - Fax:918-895-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21759261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care