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Organization
WARREN CLINIC MEDICAID GROUP 100739490B
Active
Organization
WARREN CLINIC MEDICAID GROUP 100739490B
Active
Parent organization
WARREN CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WARREN CLINIC
Authorized official
CATHEY DUPLISSEY (CREDENTIALING COORDINATOR)
(918) 488-6687
Entity
Organization
Contact information
Practice address
6600 S YALE AVE, SUITE 1400, TULSA, OK 74136-3310
(918) 488-6001
Mailing address
6600 S YALE AVE, SUITE 1400, TULSA, OK 74136-3310
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100739490B
—
OK
Enumeration date
06/02/2008
Last updated
12/13/2018
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