NPIMap

Organization Active NPI

Memorial Health Group LLC

  • Clinic/Center
  • Tulsa, OK
National Provider Identifier
1619664307
Registry record updated Mar 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MEMORIAL HEALTH GROUP LLC
Practice address
8131 S Memorial Dr Ste 100
Tulsa, OK 74133-4348
Phone
(918) 200-9944
Fax
(877) 616-3089
NPI assigned
Apr 21, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2026

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

Authorized official

Name
Matthew Dyer
Title
Owner
Phone
(918) 808-5629

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X
Clinic/Center 261Q00000X Primary
Pain Clinic/Center 261QP3300X

Addresses

Primary practice location

8131 S Memorial Dr Ste 100
Tulsa, OK 74133-4348

Mailing address

8131 S Memorial Dr Ste 100
Tulsa, OK 74133-4348
Phone (918) 200-9944

Other practice location 1

2408 E 81st St Ste 600
Tulsa, OK 74137-4316
Phone (918) 935-2040

Other practice location 2

1420 N Haskell Blvd
Haskell, OK 74436
Phone (918) 200-9944

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230710001508 OK Part B Supplier - Clinic/Group Practice 4082073093 Receives reassigned benefits from 4 practitioners
Practice locations: Haskell, OK; Tulsa, OK

National Provider Directory

National Provider Directory
Tax ID family
Memorial Health Group LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1420 N Haskell Blvd
Haskell, OK 74436
Phone (918) 200-9944

NPI Registry JSON

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

{
    "created_epoch": "1682035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774483200000",
    "number": "1619664307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8131 S MEMORIAL DR STE 100",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741334348",
            "telephone_number": "918-200-9944",
            "fax_number": "877-616-3089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8131 S MEMORIAL DR STE 100",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741334348",
            "telephone_number": "918-200-9944",
            "fax_number": "877-616-3089"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2408 E 81st St Ste 600",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741374316",
            "country_code": "US",
            "telephone_number": "918-935-2040",
            "fax_number": "918-935-2049",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1420 N HASKELL BLVD",
            "address_purpose": "LOCATION",
            "city": "HASKELL",
            "state": "OK",
            "postal_code": "74436",
            "country_code": "US",
            "telephone_number": "918-200-9944",
            "fax_number": "877-616-3089",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MEMORIAL HEALTH GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-21",
        "last_updated": "2026-03-26",
        "certification_date": "2026-03-26",
        "status": "A",
        "authorized_official_last_name": "DYER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-808-5629"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.