NPIMap

Organization Active NPI

St John Cardiovascular Medicine Inc

  • Cardiovascular Disease Physician
  • Tulsa, OK
National Provider Identifier
1790717270
Registry record updated Nov 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
ST JOHN CARDIOVASCULAR MEDICINE INC
Practice address
1923 E 21St St
Suite 200
Tulsa, OK 74114-1419
Phone
(918) 744-6966
Fax
(918) 744-9642
NPI assigned
Jul 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2007

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

Authorized official

Name
Mr. Lex Anderson
Title
Vice-President
Phone
(918) 744-3674

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

1923 E 21St St
Suite 200
Tulsa, OK 74114-1419

Mailing address

1923 E 21St St
Suite 200
Tulsa, OK 74114-1419
Phone (918) 744-6966

Other identifiers 1

IdentifierTypeStateIssuer
DE4213OtherOKRR MEDICARE

National Provider Directory

National Provider Directory

Locations

Dept 2283
Tulsa, OK 74182

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196294400000",
    "number": "1790717270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1923 E 21ST ST",
            "address_2": "SUITE 200",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741141419",
            "telephone_number": "918-744-6966",
            "fax_number": "918-744-9642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1923 E 21ST ST",
            "address_2": "SUITE 200",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741141419",
            "telephone_number": "918-744-6966",
            "fax_number": "918-744-9642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOHN CARDIOVASCULAR MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-11-29",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "LEX",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "918-744-3674",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DE4213",
            "state": "OK"
        }
    ],
    "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 Nov 29, 2007; 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.