Provider Demographics
NPI:1356351027
Name:PLANNED PARENTHOOD OF ARKANSAS AND EASTERN OKLAHOMA PEDIATRICS
Entity type:Organization
Organization Name:PLANNED PARENTHOOD OF ARKANSAS AND EASTERN OKLAHOMA PEDIATRICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR HEALTH SERVICES OP
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-587-4621
Mailing Address - Street 1:4401 W 109TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1303
Mailing Address - Country:US
Mailing Address - Phone:855-841-7526
Mailing Address - Fax:918-587-1101
Practice Address - Street 1:205 E PINE ST STE 5
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-4855
Practice Address - Country:US
Practice Address - Phone:918-587-1101
Practice Address - Fax:918-592-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100728930FMedicaid