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General NPI Number Information
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NPI Number | 1568370005
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Entity Type | Organization
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Legal Business Name | PEDIATRIC MULTISPECIALTY GROUP PLLC
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Dates
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Enumeration Date | 08/27/2026
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Last Update Date | 08/27/2026
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Provider Practice Location Address
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Address Line | 3330 NW 56TH ST STE 206
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-4426
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Country | US
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Telephone | 800-506-8933
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Fax | 855-863-6522
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Provider Business Mailing Address
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Address Line | 9235 N UNION BLVD STE 150334
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-7831
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Country | US
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Telephone | 800-506-8933
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Fax | 855-863-6522
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Authorized Official
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Title or Position | COO
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Name | AMANDA HARRIS
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Credential |
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Telephone | 800-506-8933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080S0012X
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Taxonomy Name | Pediatric Sleep Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number |
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License Number State |
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