Provider Demographics
NPI:1316131139
Name:MEDE, LLC
Entity type:Organization
Organization Name:MEDE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:VAN ANTWERP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-259-3000
Mailing Address - Street 1:5508 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-7105
Mailing Address - Country:US
Mailing Address - Phone:918-259-3000
Mailing Address - Fax:918-259-3002
Practice Address - Street 1:5508 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-7105
Practice Address - Country:US
Practice Address - Phone:918-259-3000
Practice Address - Fax:918-259-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK800522244Medicare PIN