Provider Demographics
NPI:1336416015
Name:KIDS 1ST PEDIATRIC AFTER HOURS CLINIC LLC
Entity Type:Organization
Organization Name:KIDS 1ST PEDIATRIC AFTER HOURS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARDZOG-BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-751-5437
Mailing Address - Street 1:4140 W MEMORIAL RD
Mailing Address - Street 2:SUITE 413
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8366
Mailing Address - Country:US
Mailing Address - Phone:405-751-1077
Mailing Address - Fax:405-755-0389
Practice Address - Street 1:12516 N MAY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1947
Practice Address - Country:US
Practice Address - Phone:405-751-5437
Practice Address - Fax:405-751-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care