GLORYLAND HEALTHCARE SERVICES LLC NPI 1811452907

NPI Information

NPI: 1811452907
Provider Name: GLORYLAND HEALTHCARE SERVICES, LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 37D2163607

Address:
1312 S GARNETT RD
TULSA, OK
ZIP 74128
Phone: (918) 203-3164
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GLORYLAND HEALTHCARE SERVICES, LLC is a primary care clinic center in Tulsa, OK. GLORYLAND HEALTHCARE SERVICES, LLC NPI is 1811452907. The provider is registered as an organization entity type.

The provider's business location address is:

1312 S GARNETT RD
TULSA, OK
ZIP 74128-811
Phone: (918) 203-3164
Fax: (918) 203-3163

The provider's authorized official is Augustina Agadagba .
The authorized official title is Owner and has the following contact phone number (918) 813-0511.

The CLIA number assigned to this NPI record is 37D2163607 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/4/2019 and was last updated on 2/4/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	200498000A	MEDICAID	OKLAHOMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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