Provider Demographics
NPI:1154714673
Name:TULSA VEIN INSTITUTE PLLC
Entity type:Organization
Organization Name:TULSA VEIN INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:DAVIN
Authorized Official - Last Name:HARAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-706-2161
Mailing Address - Street 1:6901 S YORKTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3986
Mailing Address - Country:US
Mailing Address - Phone:918-706-2161
Mailing Address - Fax:918-701-2021
Practice Address - Street 1:6901 S YORKTOWN AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3986
Practice Address - Country:US
Practice Address - Phone:918-706-2161
Practice Address - Fax:918-701-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK405679OtherMEDICARE PTAN
OK200582270AMedicaid