Basic Information
| Provider Information | |||||||||
| NPI: | 1265871800 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OKLAHOMA WOUND CARE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 976 MCLEAN AVE | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107044105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142376797 | ||||||||
| FaxNumber: | 9142376790 | ||||||||
| Practice Location | |||||||||
| Address1: | 10912 E 14TH ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741284845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184382440 | ||||||||
| FaxNumber: | 9184399594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2013 | ||||||||
| LastUpdateDate: | 06/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | THEODOROU | ||||||||
| AuthorizedOfficialFirstName: | SPERO | ||||||||
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| AuthorizedOfficialTitleorPosition: | SURGICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9142376797 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 228653 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.