Provider Demographics
NPI:1265871800
Name:OKLAHOMA WOUND CARE, P.C.
Entity type:Organization
Organization Name:OKLAHOMA WOUND CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SPERO
Authorized Official - Middle Name:
Authorized Official - Last Name:THEODOROU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-237-6797
Mailing Address - Street 1:976 MCLEAN AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4105
Mailing Address - Country:US
Mailing Address - Phone:914-237-6797
Mailing Address - Fax:914-237-6790
Practice Address - Street 1:10912 E 14TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-4845
Practice Address - Country:US
Practice Address - Phone:918-438-2440
Practice Address - Fax:918-439-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228653208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty