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General NPI Number Information
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NPI Number | 1073942975
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Entity Type | Organization
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Legal Business Name | WARREN CLINIC INC
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Dates
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Enumeration Date | 11/01/2013
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Last Update Date | 12/13/2018
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Provider Practice Location Address
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Address Line | 6151 S YALE AVE SUITE 1301
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City | TULSA
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State | OK
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Zip | 74136-1907
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Country | US
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Telephone | 918-502-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 S YALE AVE SUITE 1400
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City | TULSA
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State | OK
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Zip | 74136-3347
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Country | US
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Telephone | 918-488-6001
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | CATHEY R DUPLISSEY
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Credential |
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Telephone | 918-488-6687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 22448
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License Number State | OK
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