Basic Information
| Provider Information | |||||||||
| NPI: | 1215337050 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR MENS HEALTH, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5657 E 41ST ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741356010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186222500 | ||||||||
| FaxNumber: | 9186222502 | ||||||||
| Practice Location | |||||||||
| Address1: | 5657 E 41ST ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741356010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186222500 | ||||||||
| FaxNumber: | 9186222502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2014 | ||||||||
| LastUpdateDate: | 08/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | PRICE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | BLAINE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9186222500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 4111 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.