Provider Demographics
NPI:1730207788
Name:PRIMARY CARE OF TULSA
Entity type:Organization
Organization Name:PRIMARY CARE OF TULSA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TYREE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEALS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-582-7733
Mailing Address - Street 1:205 E PINE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-4859
Mailing Address - Country:US
Mailing Address - Phone:918-582-7733
Mailing Address - Fax:918-582-7755
Practice Address - Street 1:205 E PINE ST
Practice Address - Street 2:SUITE C
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-4859
Practice Address - Country:US
Practice Address - Phone:918-582-7733
Practice Address - Fax:918-582-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1477611564OtherPERSONAL NPI
OK1477611564OtherPERSONAL NPI