Provider Demographics
NPI:1235403023
Name:NEWBORN SPECIALISTS OF TULSA, PC
Entity Type:Organization
Organization Name:NEWBORN SPECIALISTS OF TULSA, PC
Other - Org Name:NEXT STEP DEVELOPMENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:WYRICK
Authorized Official - Suffix:
Authorized Official - Credentials:CAPPM
Authorized Official - Phone:918-579-5402
Mailing Address - Street 1:PO BOX 700930
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-0930
Mailing Address - Country:US
Mailing Address - Phone:918-579-5402
Mailing Address - Fax:918-579-5404
Practice Address - Street 1:1805 E 15TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4610
Practice Address - Country:US
Practice Address - Phone:918-579-5402
Practice Address - Fax:918-579-5404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEWBORN SPECIALISTS OF TULSA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-27
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty