Organization
ADA PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH WEESNER M.D. (OWNER)
(580) 332-7337
Entity
Organization
Contact information
Practice address
1414 ARLINGTON ST, SUITE 1700, ADA, OK 74820-2646
(580) 332-7337
(580) 332-3881
Mailing address
1414 ARLINGTON ST, SUITE 1700, ADA, OK 74820-2646
(580) 332-7337
(580) 332-3881
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
16267
OK
363LP0200X
Pediatric Nurse Practitioner
0065815
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100130860B
—
OK
05
—
200055950A
—
OK
Enumeration date
02/19/2013
Last updated
02/19/2013
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