JEFFREY LANE BLACK (NPI# 1700957990) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1700957990 |
Entity Type | Individual |
Full Name | JEFFREY LANE BLACK |
Practice Address |
1717 S Utica Ave Ste A Tulsa OK 74104-5346 |
Mailing Address |
1515 N Harvard Ave Ste E Tulsa OK 74115-4957 |
Practice Telephone | 9187487557 |
Practice Fax Number | 9187487514 |
Mailing Telephone | 9188326049 |
Mailing Fax Number | 9188326055 |
Enumeration Date | 2006-11-11 |
Last Update Date | 2010-04-13 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
16468 | OK | Allopathic & Osteopathic Physicians |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1235419896 | Jeffrey Allen Black | Pharmacist | 1925 Zero St, Fort Smith, AR 72901-8415 | 2011-08-26 |
1760474035 | Jeffrey L. Black | Radiology | 418 30th St, Oakland, CA 94609-3302 | 2005-08-22 |
1336646629 | Jeffrey Ryne Black | General Practice | 625 19th St S, Birmingham, AL 35233-1900 | 2018-04-12 |
1265854905 | Jeffrey Black | Pediatrics | 2222 Welborn St, Dallas, TX 75219-3924 | 2014-01-15 |
1770920894 | Jeffrey Black | Technician | 700 Chief Eddie Hoffman Highway, Bethel, AK 99559-0528 | 2013-05-30 |
1538137112 | Jeffrey B Black | Family Medicine | 7205 265th St Nw, Stanwood, WA 98292-6221 | 2006-03-09 |
Street Address |
1717 S UTICA AVE STE A |
City | TULSA |
State | OK |
Zip Code | 74104-5346 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1558359505 | Richard P Holsopple II | Emergency Medicine | 1717 S Utica Ave Ste A, Tulsa, OK 74104-5346 | 2005-10-12 |
1396380259 | Kassandra D Delcoure | Registered Nurse | 1717 S Utica Ave Ste A, Tulsa, OK 74104-5342 | 2019-11-14 |
1588172415 | Kristen Paige Smith | Physician Assistant | 1717 S Utica Ave Ste A, Tulsa, OK 74104-5346 | 2018-01-12 |
1740796606 | Virginia Corcoran | Physician Assistant | 1717 S Utica Ave Ste A, Tulsa, OK 74104 | 2017-12-14 |
1366976391 | Adrienne Taren | Emergency Medicine | 1717 S Utica Ave Ste A, Tulsa, OK 74104-5346 | 2017-04-17 |
1801331871 | Karen Gwen Smith | Registered Nurse | 1717 S Utica Ave Ste A, Tulsa, OK 74104-5346 | 2016-12-30 |
1366822033 | Rebecca Massey | Emergency Medicine | 1717 S Utica Ave Ste A, Tulsa, OK 74104-5346 | 2015-06-08 |
1578950671 | Robyn Lovitt | Emergency Medicine | 1717 S Utica Ave Ste A, Tulsa, OK 74104 | 2015-04-16 |
1063801660 | John Clay Bowen | Emergency Medicine | 1717 S Utica Ave Ste A, Tulsa, OK 74104-5346 | 2015-01-20 |
1386046753 | Ricky Atwood | Nurse Practitioner | 1717 S Utica Ave Ste A, Tulsa, OK 74104-5346 | 2014-09-17 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982253811 | Ultimate Health and Pain Management | Pain Medicine | 1844 East 15th Street, Tulsa, OK 74104 | 2019-09-04 |
1225691223 | David Murray | Student in an Organized Health Care Education/Training Program | 2100 S Wheeling Ave, Tulsa, OK 74104 | 2019-04-16 |
1083115828 | Susan Fortner | Counselor | 1328 S. Delaware Pl, Tulsa, OK 74104 | 2018-02-27 |
1033636915 | Mark Brizendine | Dietitian, Registered | Hillcrest Medical Center 1120 S. Utica Ave, Tulsa, OK 74104 | 2017-08-23 |
1295259067 | Demi Reyd Cook | Nurse Practitioner | 1717 A South Utica, Tulsa, OK 74104 | 2017-08-02 |
1851827059 | Oklahoma Cvs Pharmacy | Durable Medical Equipment & Medical Supplies | 1701 E 15th Street, Tulsa, OK 74104 | 2017-05-08 |
1801334982 | Jamie Lynne Miller | Internal Medicine | 2000 S. Wheeling Avenue Ste 510, Tulsa, OK 74104 | 2017-02-08 |
1578913430 | Donna Durant-macon | Registered Nurse | 315 South Utica, Tulsa, OK 74104 | 2016-06-21 |
1669833851 | Mbc Dental | Dentist | 401 S. Utica Ave, #a, Tulsa, OK 74104 | 2016-03-15 |
1518332170 | Neuro Dynamics LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 22 S Lewis, Tulsa, OK 74104 | 2015-12-08 |
Find all providers in zip 74104 |
Taxonomy Code | 207PE0004X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Emergency Medicine |
Specialization | Emergency Medical Services |
An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1326149048 | Nadim N Daher | Emergency Medicine | 802 S Jackson Ave Ste 310, Tulsa, OK 74127-9057 | 2006-09-26 |
1134186299 | Boyd David Burns | Emergency Medicine | 4502 E. 41st St, Tulsa, OK 74135-9923 | 2006-05-01 |
1649235532 | Stephen R Gilliland | Emergency Medicine | 8813 S 71st East Ave, Tulsa, OK 74133-5056 | 2006-04-20 |
1841260015 | Joseph M. Nicholson IIi | Emergency Medicine | 1435 S Utica Ave, Tulsa, OK 74104-4649 | 2006-01-23 |
1225018757 | Stanley R Stacy | Emergency Medicine | 7153 S Yale Ave, Tulsa, OK 74136-6308 | 2006-01-19 |
1255321162 | Joe D Sagely | Emergency Medicine | 1217 E 48th St, Tulsa, OK 74105 | 2005-10-24 |
1245220144 | Jason A. Logan | Emergency Medicine | 7600 S Lewis Ave, Tulsa, OK 74136-6836 | 2005-10-24 |
1558359505 | Richard P Holsopple II | Emergency Medicine | 1717 S Utica Ave Ste A, Tulsa, OK 74104-5346 | 2005-10-12 |
1508424755 | Tulsa Ep, Pllc | Emergency Medicine | 717 W. 71st Street, Tulsa, OK 74132 | 2019-06-03 |
1063801660 | John Clay Bowen | Emergency Medicine | 1717 S Utica Ave Ste A, Tulsa, OK 74104-5346 | 2015-01-20 |
Find all providers in TULSA |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.