Provider Demographics
NPI:1699963264
Name:KICKINGBIRD FAMILY MEDICINE PLLC
Entity type:Organization
Organization Name:KICKINGBIRD FAMILY MEDICINE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-330-1478
Mailing Address - Street 1:PO BOX 31266
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-0022
Mailing Address - Country:US
Mailing Address - Phone:405-330-1478
Mailing Address - Fax:405-330-6231
Practice Address - Street 1:2820 N KELLY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-3007
Practice Address - Country:US
Practice Address - Phone:405-330-1478
Practice Address - Fax:405-330-6231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center