Provider Demographics
NPI:1194701516
Name:AHS TULSA REGIONAL MEDICAL CENTER LLC
Entity type:Organization
Organization Name:AHS TULSA REGIONAL MEDICAL CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-579-5835
Mailing Address - Street 1:744 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-9020
Mailing Address - Country:US
Mailing Address - Phone:918-587-2561
Mailing Address - Fax:
Practice Address - Street 1:744 W 9TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9020
Practice Address - Country:US
Practice Address - Phone:918-579-5836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARDENT HEALTH SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-17
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2260282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK370078B000000OtherTRAILBLAZER UND. ALIENS
OK370078OtherSTERLING OPTION 1
PA101266593 0001Medicaid
OK6470825OtherAETNA
MO010851509Medicaid
OK200048610AMedicaid
OK000370078001OtherBLUE CROSS PROV NUMBER
OK611043400OtherDEPARTMENT OF LABOR
OK6470825OtherAETNA
OK370078B000000OtherTRAILBLAZER UND. ALIENS