Organization
WARREN CLINIC MEMORIAL SOUTH PEDIATRICS SOONERCARE GROUP
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
8414 E 101ST ST, TULSA, OK 74133-6919
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100739490T
—
OK
Enumeration date
06/02/2008
Last updated
06/02/2008
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