Provider Demographics
NPI:1487172623
Name:TULSA MICRO HOSPITAL, LLC
Entity type:Organization
Organization Name:TULSA MICRO HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAUBART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-202-3831
Mailing Address - Street 1:1415 LOUISIANA ST FL 27
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-7360
Mailing Address - Country:US
Mailing Address - Phone:713-202-3831
Mailing Address - Fax:
Practice Address - Street 1:717 WEST 71ST STREET
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132
Practice Address - Country:US
Practice Address - Phone:713-202-3831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty