Provider Demographics
NPI:1902177769
Name:BIXBY PEDIATRICS PLLC
Entity Type:Organization
Organization Name:BIXBY PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NIDHI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-439-6461
Mailing Address - Street 1:11063D SOUTH MEMORIAL DR.
Mailing Address - Street 2:422
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133
Mailing Address - Country:US
Mailing Address - Phone:918-439-6461
Mailing Address - Fax:
Practice Address - Street 1:11063D SOUTH MEMORIAL DR.
Practice Address - Street 2:422
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-439-6461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26393261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care