Warren Clinic Broken Arrow Pediatrics Soonercare Group

NPI #1992963383 in Tulsa, Oklahoma

Provider Information

NPI Number: 1992963383
Entity Type: Organization
Organization Name: Warren Clinic Broken Arrow Pediatrics Soonercare Group
Subpart: Yes (part of a larger organization)
Parent Organization: WARREN CLINIC
Primary Specialty: Pediatrics
Enumeration Date: Jun 2, 2008
Last Updated: Jun 2, 2008

Practice Location

Address: 6600 S YALE AVE
Address 2: STE 1400
City: Tulsa
State: Oklahoma
ZIP Code: 74136-3310
Phone: (918) 488-6001

Authorized Official

Name: KATHY MASON
Title: CREDENTIALING COORDINATOR
Phone: (918) 488-6687

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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