Provider Demographics
NPI:1285891945
Name:KIDS PEDIATRIC AND ADOLESCENT CARE
Entity type:Organization
Organization Name:KIDS PEDIATRIC AND ADOLESCENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KNIPPERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-394-5437
Mailing Address - Street 1:7711 E 111TH ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-2570
Mailing Address - Country:US
Mailing Address - Phone:918-394-5437
Mailing Address - Fax:
Practice Address - Street 1:7711 E 111TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-2570
Practice Address - Country:US
Practice Address - Phone:918-394-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK138602080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE62330Medicare UPIN