# WARREN CLINIC VINITA FEE FOR SERVICE GROUP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WARREN CLINIC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1659539047
- **Legal business name:** WARREN CLINIC
- **Authorized official:** KATHY MASON (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (918) 488-6687

## Contact information

- **Practice address:** 6600 S YALE AVE, SUITE 1400, TULSA, OK 74136-3310
- **Practice address phone:** (918) 488-6001
- **Mailing address:** 715 N FOREMAN ST, VINITA, OK 74301-1422

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/02/2008
- **Last updated:** 06/02/2008