1336416015 NPI number — KIDS 1ST PEDIATRIC AFTER HOURS CLINIC LLC

Table of content: (NPI 1336416015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336416015 NPI number — KIDS 1ST PEDIATRIC AFTER HOURS CLINIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDS 1ST PEDIATRIC AFTER HOURS CLINIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336416015
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4140 W MEMORIAL RD
Provider Second Line Business Mailing Address:
SUITE 413
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73120-8366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-751-1077
Provider Business Mailing Address Fax Number:
405-755-0389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12516 N MAY AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73120-1947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-751-5437
Provider Business Practice Location Address Fax Number:
405-751-5441
Provider Enumeration Date:
11/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HARDZOG-BRITT
Authorized Official First Name:
CARLA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
405-751-5437

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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