Caresource-Tulsa, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

CARESOURCE-TULSA, LLC

Practice address

1400 SW Expressway Dr
Broken Arrow, OK 74012

Phone

(918) 250-7051

Fax

(918) 392-3442

NPI assigned

Aug 25, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Larry Pierce

Title

Executive Director

Phone

(405) 948-2822

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1013024710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270214",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731370214",
            "telephone_number": "918-250-7051",
            "fax_number": "918-392-3442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 SW EXPRESSWAY DR",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "74012",
            "telephone_number": "918-250-7051",
            "fax_number": "918-392-3442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARESOURCE-TULSA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PIERCE",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "405-948-2822",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200074940A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.