Provider Demographics
NPI:1124451455
Name:TULSA-AMG SPECIALTY HOSPITAL, LLC
Entity type:Organization
Organization Name:TULSA-AMG SPECIALTY HOSPITAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUST
Authorized Official - Middle Name:J
Authorized Official - Last Name:RANTZ
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:337-269-9566
Mailing Address - Street 1:101 LA RUE FRANCE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3144
Mailing Address - Country:US
Mailing Address - Phone:337-269-9566
Mailing Address - Fax:337-223-4107
Practice Address - Street 1:2408 E 81ST ST
Practice Address - Street 2:STE 2800
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4200
Practice Address - Country:US
Practice Address - Phone:918-744-3047
Practice Address - Fax:918-744-3043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK372011Medicare PIN