Organization
WARREN CLINIC STILLWATER SOONERCARE
Active
Parent organization
WARREN CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WARREN CLINIC
Authorized official
KATHY MASON (CREDENTIALING COORDINATOR)
(918) 488-6687
Entity
Organization
Contact information
Practice address
6600 S YALE AVE, STE 1400, TULSA, OK 74136-3310
(918) 488-6001
Mailing address
1815 W 6TH AVE, STILLWATER, OK 74074-4202
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100739490Q
—
OK
Enumeration date
06/02/2008
Last updated
06/02/2008
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