Provider Demographics
NPI:1114366341
Name:NEXT GENERATION PEDIATRICS, LLC
Entity Type:Organization
Organization Name:NEXT GENERATION PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:KUECHENMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-378-2222
Mailing Address - Street 1:PO BOX 890070
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-0070
Mailing Address - Country:US
Mailing Address - Phone:405-378-2222
Mailing Address - Fax:405-378-2240
Practice Address - Street 1:10400 S WESTERN AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-3016
Practice Address - Country:US
Practice Address - Phone:405-378-2222
Practice Address - Fax:405-378-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty