Provider Demographics
NPI:1972332625
Name:TULSA ACCIDENT CARE CENTER LLC
Entity type:Organization
Organization Name:TULSA ACCIDENT CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-888-8080
Mailing Address - Street 1:5705 E 71ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6651
Mailing Address - Country:US
Mailing Address - Phone:918-888-8080
Mailing Address - Fax:
Practice Address - Street 1:314 E 5TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-3484
Practice Address - Country:US
Practice Address - Phone:918-888-8080
Practice Address - Fax:918-888-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty