NPIMap

Organization Active NPI

Warren Clinic Broken Arrow Pediatrics Soonercare Group

  • Pediatrics Physician
  • Tulsa, OK
National Provider Identifier
1992963383
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 BROKEN ARROW 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

Authorized official

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

Practitioners 5

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

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

2950 S Elm Pl
Ste 430
Broken Arrow, OK 74012
Phone (918) 449-4061

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

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

Mailing address

2950 S Elm PL
Ste 430
Broken Arrow, OK 74012-7877

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
100739490SMedicaidOK

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 2, 2008.

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212364800000",
    "number": "1992963383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2950 S ELM PL",
            "address_2": "STE 430",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740127877"
        },
        {
            "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 BROKEN ARROW 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": "100739490S",
            "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.