Provider Demographics
NPI:1699668426
Name:VINEYARD MEDICAL CARE, LLC
Entity type:Organization
Organization Name:VINEYARD MEDICAL CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:VINEYARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-392-5555
Mailing Address - Street 1:11917 S NORWOOD AVE # 212
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-5509
Mailing Address - Country:US
Mailing Address - Phone:918-392-5555
Mailing Address - Fax:918-392-5566
Practice Address - Street 1:11917 S NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-5509
Practice Address - Country:US
Practice Address - Phone:918-392-5555
Practice Address - Fax:918-392-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-30
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty