| Diabetic Centers For Excellence Llc | |
|
8640 S Peoria Ave Tulsa OK 74132-2827 | |
| (213) 840-1161 | |
| Not Available |
| Full Name | Diabetic Centers For Excellence Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 8640 S Peoria Ave, Tulsa, Oklahoma |
| Authorized Official Name and Position | Christopher Myers (CEO) |
| Authorized Official Contact | 2138401161 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diabetic Centers For Excellence Llc 4215 Glencoe Ave Unit 121 Marina Del Rey CA 90292-4622 Ph: () - | Diabetic Centers For Excellence Llc 8640 S Peoria Ave Tulsa OK 74132-2827 Ph: (213) 840-1161 |
| NPI Number | 1043993546 |
|---|---|
| Provider Enumeration Date | 08/10/2023 |
| Last Update Date | 08/10/2023 |
| Medicare PECOS PAC ID | 8123476926 |
|---|---|
| Medicare Enrollment ID | O20231204002069 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043993546 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Primary |
| Provider Name | Nichole Marie Blackburn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154027829 PECOS PAC ID: 0244684587 Enrollment ID: I20230920003672 |
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