NPIMap

Organization Active NPI

Warren Clinic Kelly Pediatrics Soonercare Group

  • Pediatrics Physician
  • Tulsa, OK
National Provider Identifier
1457519845
Registry record updated Jun 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
WARREN CLINIC KELLY PEDIATRICS SOONERCARE GROUP
Practice address
6600 S Yale Ave
Ste 1400
Tulsa, OK 74136-3310
Phone
(918) 488-6001
NPI assigned
Jun 2, 2008
Organization subpart
Yes
Parent organization
WARREN CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 2, 2008

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

Authorized official

Name
Kathy Mason
Title
Credentialing Coordinator
Phone
(918) 488-6687

Specialties & licenses 1

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

Addresses

Primary practice location

6600 S Yale Ave
Ste 1400
Tulsa, OK 74136-3310

Mailing address

6565 S Yale Ave
Ste 704
Tulsa, OK 74136-8327

Other identifiers 1

IdentifierTypeStateIssuer
100739490VMedicaidOK

National Provider Directory

National Provider Directory
Tax ID family
Dr Donald E Loveless17 organizations share this tax ID, including this one
Part of
Dr Donald E Loveless

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Locations

6565 S Yale Ave
Ste 704
Tulsa, OK 74136
Phone (918) 494-9400

Practitioners & affiliated clinicians

Practitioners 4

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": "1212364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212364800000",
    "number": "1457519845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6565 S YALE AVE",
            "address_2": "STE 704",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741368327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 S YALE AVE",
            "address_2": "STE 1400",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363310",
            "telephone_number": "918-488-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WARREN CLINIC KELLY PEDIATRICS SOONERCARE GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WARREN CLINIC",
        "enumeration_date": "2008-06-02",
        "last_updated": "2008-06-02",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "918-488-6687"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100739490V",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; 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.