NPIMap

Organization Active NPI

Park Place Medical

  • Pediatrics Physician
  • Mustang, OK
National Provider Identifier
1114334885
Registry record updated Jul 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
15742 Issued in OK
Legal business name
PARK PLACE MEDICAL
Practice address
500 Park PL
Mustang, OK 73064-3104
Phone
(406) 376-5439
Fax
(405) 376-6459
NPI assigned
Jul 15, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Donna Raye Cosby, MDNPI 1326030131
Title
Owner
Phone
(405) 376-5439

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 15742 OK Primary

Addresses

Primary practice location

500 Park PL
Mustang, OK 73064-3104

Mailing address

500 Park PL
Mustang, OK 73064-3104
Phone (406) 376-5439

National Provider Directory

National Provider Directory

Locations

500 Park Pl
Mustang, OK 73064
Phone (405) 376-5439

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405382400000",
    "number": "1114334885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 PARK PL",
            "city": "MUSTANG",
            "state": "OK",
            "postal_code": "730643104",
            "telephone_number": "406-376-5439",
            "fax_number": "405-376-6459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 PARK PL",
            "city": "MUSTANG",
            "state": "OK",
            "postal_code": "730643104",
            "telephone_number": "406-376-5439",
            "fax_number": "405-376-6459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK PLACE MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-15",
        "last_updated": "2014-07-15",
        "status": "A",
        "authorized_official_last_name": "COSBY",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "RAYE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-376-5439",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "15742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mustang, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.