Healthcare Provider Details

I. General information

NPI: 1568370005
Provider Name (Legal Business Name): PEDIATRIC MULTISPECIALTY GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 NW 56TH ST STE 206
OKLAHOMA CITY OK
73112-4426
US

IV. Provider business mailing address

9235 N UNION BLVD STE 150334
COLORADO SPRINGS CO
80920-7831
US

V. Phone/Fax

Practice location:
  • Phone: 800-506-8933
  • Fax: 855-863-6522
Mailing address:
  • Phone: 800-506-8933
  • Fax: 855-863-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA HARRIS
Title or Position: COO
Credential:
Phone: 800-506-8933