Grand Prairie Pediatric and Allergy Clinic Inc

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

11030 Issued in OK

Legal business name

GRAND PRAIRIE PEDIATRIC AND ALLERGY CLINIC INC

Practice address

7301 N Comanche Ave
Oklahoma City, OK 73132

Phone

(405) 721-8090

Fax

(405) 722-8529

NPI assigned

Apr 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth Charles Jackson, MD

Title

Pres

Phone

(405) 721-8090

Specialties & licenses 1

Addresses

Tax ID family

Grand Prairie Pedallergy CLN2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Grand Prairie Pediatric and Allergy Clinic

  • Preferred Provider Organization
  • Warr Acres, OK
  • NPI 1588716104
  NPD tax ID

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337904000000",
    "number": "1952368664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7301 N COMANCHE AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73132",
            "telephone_number": "405-721-8090",
            "fax_number": "405-722-8529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7301 N COMANCHE AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73132",
            "telephone_number": "405-721-8090",
            "fax_number": "405-722-8529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND PRAIRIE PEDIATRIC AND ALLERGY CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2012-05-25",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PRES",
        "authorized_official_telephone_number": "405-721-8090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "11030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dimanique T Granados
• Kimberly Brade Granato, PHARMD.
• Stephani Lynn Granato, PHD
• Grand Lake Mental Health Center, Inc.
• Grand Lake Mental Health Center, Inc.
• Grand Primary Care Clinics
• Grand Slam Rehabilitation L.L.C.
• Grand Village in Home Care
• Michael Henry Grandison, DO
• Gloria Granillo

• Pediatrics Physician in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Pediatrics Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2012; 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.