Organization
WARREN CLINIC BROKEN ARROW 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
2950 S ELM PL, STE 430, BROKEN ARROW, OK 74012-7877
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100739490S
—
OK
Enumeration date
06/02/2008
Last updated
06/02/2008
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