NPIMap

Organization Active NPI

Tracey W. Childers, D.O. P.C.

Doing business as Childers Medical Group

  • Otolaryngology Physician
  • Tahlequah, OK
National Provider Identifier
1720274699
Registry record updated Sep 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
3296 Issued in OK
Legal business name
TRACEY W. CHILDERS, D.O. P.C.
Doing business as
Childers Medical Group
Practice address
1203 E Ross Byp
Suite a
Tahlequah, OK 74464-4188
Phone
(918) 453-1234
Fax
(918) 453-9107
NPI assigned
Sep 24, 2007
Last updated
Sep 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2010

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

Authorized official

Name
Tracey W Childers, DONPI 1053371021
Title
Medical Director
Phone
(918) 453-1234

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
Otolaryngology Physician 207Y00000X 3296 OK Primary

Addresses

Primary practice location

1203 E Ross Byp
Suite a
Tahlequah, OK 74464-4188

Mailing address

1203 E Ross Byp
Suite a
Tahlequah, OK 74464-4133
Phone (918) 453-1234

Other identifiers 1

IdentifierTypeStateIssuer
200000030AMedicaidOK

Other names 1

  • Childers Medical Group Doing business as

National Provider Directory

National Provider Directory

Locations

1203 E Ross Byp
Ste A
Tahlequah, OK 74464
Phone (918) 453-1234

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284508800000",
    "number": "1720274699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 E ROSS BYP",
            "address_2": "SUITE A",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744644133",
            "telephone_number": "918-453-1234",
            "fax_number": "918-453-9107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 E ROSS BYP",
            "address_2": "SUITE A",
            "city": "TAHLEQUAH",
            "state": "OK",
            "postal_code": "744644188",
            "telephone_number": "918-453-1234",
            "fax_number": "918-453-9107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRACEY W. CHILDERS, D.O. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-24",
        "last_updated": "2010-09-15",
        "status": "A",
        "authorized_official_last_name": "CHILDERS",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "918-453-1234",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "OK",
            "license": "3296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200000030A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Childers Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tahlequah, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2010; 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.