NPIMap

Organization Active NPI

Warren Clinic Sand Springs Soonercare Group

  • Pediatrics Physician
  • Tulsa, OK
National Provider Identifier
1912165309
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 SAND SPRINGS SOONERCARE GROUP
Practice address
6600 S Yale Ave
Ste 1400
Tulsa, OK 74136-3310
Phone
(918) 488-6001
NPI assigned
Jun 2, 2008
Last updated
Jun 2, 2008By the provider in NPPES
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 Physician 208000000X Primary

Addresses

Primary practice location

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

Mailing address

796 E Charles Page Blvd
Sand Springs, OK 74063-8507

Other identifiers 1

IdentifierTypeStateIssuer
100739490UMedicaidOK

National Provider Directory

National Provider Directory
Tax ID family
Patrick F McGowan MD17 organizations share this tax ID, including this one
Part of
Patrick F McGowan MD

Other organizations with this tax ID 16

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

View all 16

Locations

796 E Charles Page Blvd
Sand Springs, OK 74063
Phone (918) 245-2286

Practitioners & affiliated clinicians

Practitioners 3

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": "1212364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212364800000",
    "number": "1912165309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "796 E CHARLES PAGE BLVD",
            "city": "SAND SPRINGS",
            "state": "OK",
            "postal_code": "740638507"
        },
        {
            "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 SAND SPRINGS 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": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100739490U",
            "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.