Provider Demographics
NPI:1366875999
Name:MIDTOWN MEDICAL NEUROPATHY, LLC
Entity type:Organization
Organization Name:MIDTOWN MEDICAL NEUROPATHY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WARNER
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-794-3274
Mailing Address - Street 1:3311 S YALE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-8036
Mailing Address - Country:US
Mailing Address - Phone:918-794-3274
Mailing Address - Fax:918-794-3277
Practice Address - Street 1:3311 S YALE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-8036
Practice Address - Country:US
Practice Address - Phone:918-794-3274
Practice Address - Fax:918-794-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain