| Family Medical Practice | |
|
4134 S Harvard Ave Ste B3 Tulsa OK 74135-2613 | |
| (918) 442-2236 | |
| (918) 794-2333 |
| Full Name | Family Medical Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 4134 S Harvard Ave Ste B3, Tulsa, Oklahoma |
| Authorized Official Name and Position | Tandaleo Gamble (CEO) |
| Authorized Official Contact | 9187602200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medical Practice 4134 S Harvard Ave Ste B3 Tulsa OK 74135-2613 Ph: (918) 442-2236 | Family Medical Practice 4134 S Harvard Ave Ste B3 Tulsa OK 74135-2613 Ph: (918) 442-2236 |
| NPI Number | 1013510775 |
|---|---|
| Provider Enumeration Date | 11/17/2020 |
| Last Update Date | 04/12/2022 |
| Medicare PECOS PAC ID | 0345658472 |
|---|---|
| Medicare Enrollment ID | O20210409000625 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013510775 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ulysses Bowler |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1942290788 PECOS PAC ID: 2163447731 Enrollment ID: I20051012000876 |
| Provider Name | Tandaleo Gamble |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578025078 PECOS PAC ID: 3173857281 Enrollment ID: I20190624002511 |
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