Epiphany Dermatology Of Oklahoma, LLC
Dermatology in Tulsa, OK. Organization (NPI-2).
NPI number1801320106
StatusActive
Last updated in NPPESDec 7, 2023
Details
- NPI
- 1801320106
- Entity type
- Organization (NPI-2)
- Legal business name
- Epiphany Dermatology Of Oklahoma, LLC
- Organization subpart
- No
- Enumeration date
- Apr 13, 2017
- Certification date
- Dec 7, 2023
- Last updated
- Dec 7, 2023
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | – | – | Yes |
Practice location
10115 E 80th St Ste ATulsa, OK 74133-3421
Phone 512-628-0465 · Fax 512-628-0468
Mailing address
7300 Ranch Rd. 2222, Bldg 1, Ste 200Suite 200
Austin, TX 78730
Phone 512-628-0465
Authorized official
Gheorghe Pusta
Ceo
5126280465
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