| Nr South Tulsa Llc | |
|
9101 S Toledo Ave Ste A Tulsa OK 74137-2719 | |
| (918) 398-0802 | |
| (405) 669-3517 |
| Full Name | Nr South Tulsa Llc |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 9101 S Toledo Ave Ste A, Tulsa, Oklahoma |
| Authorized Official Name and Position | Timothy C Bales (CEO/OWNER) |
| Authorized Official Contact | 4059537221 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nr South Tulsa Llc 3705 Nw 63rd St Ste 200 Oklahoma City OK 73116-1937 Ph: (405) 953-7221 | Nr South Tulsa Llc 9101 S Toledo Ave Ste A Tulsa OK 74137-2719 Ph: (918) 398-0802 |
| NPI Number | 1871303313 |
|---|---|
| Provider Enumeration Date | 01/08/2025 |
| Last Update Date | 03/03/2025 |
| Medicare PECOS PAC ID | 1355870312 |
|---|---|
| Medicare Enrollment ID | O20250121003387 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871303313 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Primary |
| Provider Name | Damaris G Deutsch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699862573 PECOS PAC ID: 2163473208 Enrollment ID: I20050204000814 |
| Provider Name | Jennifer Hinkle |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1003057670 PECOS PAC ID: 6002967429 Enrollment ID: I20140929000153 |
| Provider Name | Linda Ellard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265948269 PECOS PAC ID: 6901167287 Enrollment ID: I20180301000613 |
| Provider Name | Latrica Louise Dorsey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538696083 PECOS PAC ID: 1658777024 Enrollment ID: I20210909003063 |
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