# WARREN CLINIC SOUTH FAMILY MEDICINE SOONERCARE GROUP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1861650251
- **Legal business name:** WARREN CLINIC
- **Authorized official:** CATHEY RAE DUPLISSEY (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (918) 488-6687

## Contact information

- **Practice address:** 6600 S YALE AVE, STE 1400, TULSA, OK 74136-3310
- **Practice address phone:** (918) 488-6001
- **Mailing address:** 10505 E 91ST ST, SUITE 110, TULSA, OK 74133-5801

## 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:** 11/13/2017