Healthcare Provider Details

I. General information

NPI: 1780789362
Provider Name (Legal Business Name): CHILDREN & ADOLESCENT MEDICAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 S. 101ST E. AVE. SUITE 200
TULSA OK
74133
US

IV. Provider business mailing address

8803 S. 101ST E. AVE. SUITE 200
TULSA OK
74133
US

V. Phone/Fax

Practice location:
  • Phone: 918-307-2273
  • Fax: 918-307-0273
Mailing address:
  • Phone: 918-307-2273
  • Fax: 918-307-0273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JANELL P CYRUS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 918-307-2273