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General NPI Number Information
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NPI Number | 1730162793
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Entity Type | Organization
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Legal Business Name | KIDS HEALTH CARE PC
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8803 S 101ST EAST AVE 275
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City | TULSA
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State | OK
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Zip | 74133-5726
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Country | US
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Telephone | 918-252-5437
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Fax | 918-459-5437
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Provider Business Mailing Address
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Address Line | 8803 S 101ST EAST AVE 275
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City | TULSA
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State | OK
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Zip | 74133-5726
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Country | US
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Telephone | 918-252-5437
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Fax | 918-459-5437
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CAROLE BRANDL
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Credential |
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Telephone | 918-252-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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