Provider Demographics
NPI:1992063655
Name:BELLHAVEN MEDICAL SPA, LLC
Entity type:Organization
Organization Name:BELLHAVEN MEDICAL SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:WROBERSON
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-697-6889
Mailing Address - Street 1:1878 E. 15TH ST.
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104
Mailing Address - Country:US
Mailing Address - Phone:918-938-7026
Mailing Address - Fax:918-938-7748
Practice Address - Street 1:1878 E. 15TH ST.
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-938-7026
Practice Address - Fax:918-938-7748
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELLHAVEN MEDICAL SPA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty