Basic Information
| Provider Information | |||||||||
| NPI: | 1104071257 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THERAPEUTIC CARE DIMENSIONS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 419 W GRAY ST | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730697117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058094200 | ||||||||
| FaxNumber: | 4053645379 | ||||||||
| Practice Location | |||||||||
| Address1: | 12101 N MACARTHUR BLVD | ||||||||
| Address2: | STE 103 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731621800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056507577 | ||||||||
| FaxNumber: | 4054707428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2008 | ||||||||
| LastUpdateDate: | 11/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | MASON | ||||||||
| AuthorizedOfficialFirstName: | MARIE | ||||||||
| AuthorizedOfficialMiddleName: | HELEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4056507577 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ARNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R0029205 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.