Provider Demographics
NPI:1194751495
Name:CARDIOLOGY DIAGNOSTICS OF TULSA
Entity type:Organization
Organization Name:CARDIOLOGY DIAGNOSTICS OF TULSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:SPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-494-8500
Mailing Address - Street 1:6151 S YALE AVE
Mailing Address - Street 2:#400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1907
Mailing Address - Country:US
Mailing Address - Phone:918-494-8500
Mailing Address - Fax:918-307-5578
Practice Address - Street 1:6151 S YALE AVE
Practice Address - Street 2:#400
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1907
Practice Address - Country:US
Practice Address - Phone:918-494-8500
Practice Address - Fax:918-307-5578
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARDIOLOGY OF TULSA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-25
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100738900AMedicaid
OKCS9846OtherRAILROAD MEDICARE
OK400522001Medicare PIN