Provider Demographics
NPI:1063610087
Name:SPINAL THERAPEUTIC SERVICES INC
Entity type:Organization
Organization Name:SPINAL THERAPEUTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:HUEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-743-1133
Mailing Address - Street 1:4415 S HARVARD AVE
Mailing Address - Street 2:STE. 204
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2620
Mailing Address - Country:US
Mailing Address - Phone:918-743-1133
Mailing Address - Fax:918-743-6993
Practice Address - Street 1:4415 S HARVARD AVE
Practice Address - Street 2:STE. 204
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2620
Practice Address - Country:US
Practice Address - Phone:918-743-1133
Practice Address - Fax:918-743-6993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK444429855003OtherBLUE CROSS
OKD42843Medicare UPIN