MEDICARE: SOUTHERN OKLAHOMA PEDIATRICS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	11462	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780705772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN OKLAHOMA PEDIATRICS INC

Provider Business Mailing Address
First Line	:	1214 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-4045
Country	:	US
Telephone Number	:	580-436-2283
Fax Number	:	580-436-2291

Provider Business Practice Location Address
First Line	:	1214 ARLINGTON ST
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-4045
Country	:	US
Telephone Number	:	580-436-2283
Fax Number	:	580-436-2291

Authorized Official
Title or Position	:	PEDIATRICIAN
Name	:	DR. TAWFIK Z RAMADAN
Credential	:	M.D.
Telephone Number	:	580-436-2283

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	01/07/2010

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