Provider Demographics
NPI:1023851177
Name:KIDS PEDIATRIC CARE LLC
Entity type:Organization
Organization Name:KIDS PEDIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PFANSTIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-225-1497
Mailing Address - Street 1:7711 E 111TH ST STE 111
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-2563
Mailing Address - Country:US
Mailing Address - Phone:682-225-1497
Mailing Address - Fax:918-394-5400
Practice Address - Street 1:7711 E 111TH ST STE 111
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-2563
Practice Address - Country:US
Practice Address - Phone:918-394-5437
Practice Address - Fax:918-394-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty