Provider Demographics
NPI:1386765337
Name:BEBECITOS CHILDRENS CLINIC
Entity type:Organization
Organization Name:BEBECITOS CHILDRENS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPEC
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-475-0175
Mailing Address - Street 1:PO BOX 6521
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73506-0521
Mailing Address - Country:US
Mailing Address - Phone:580-351-9949
Mailing Address - Fax:580-351-9989
Practice Address - Street 1:4008 NW CACHE RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3634
Practice Address - Country:US
Practice Address - Phone:580-351-9949
Practice Address - Fax:580-351-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty