Cedar Ridge Clinic,P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

3313 Issued in OK

Legal business name

CEDAR RIDGE CLINIC,P.C.

Practice address

10016 S Mingo Rd Ste a
Tulsa, OK 74133-5789

Phone

(918) 459-0583

Fax

(918) 250-0120

NPI assigned

Jul 8, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Trung H Pham, D.O.NPI 1700851052

Title

Physician

Phone

(918) 459-0583

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 1

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

• Trung H Pham, D.O.

  • Family Medicine Physician
  • Tulsa, OK
  • NPI 1700851052
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1278547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290470400000",
    "number": "1366754202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10016 S MINGO RD STE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741335789",
            "telephone_number": "918-459-0583",
            "fax_number": "918-250-0120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10016 S MINGO RD STE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741335789",
            "telephone_number": "918-459-0583",
            "fax_number": "918-250-0120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR RIDGE CLINIC,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-08",
        "last_updated": "2010-11-23",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "TRUNG",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "918-459-0583",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "3313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100223040F",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Karamba J Ceesay, M.D.
• Mariama Camara Ceesay
• Melissa Kay Cejda, RD/LD
• Taryn Elesia Celestine

• Family Medicine Physician in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.