Provider Demographics
NPI:1780789362
Name:CHILDREN & ADOLESCENT MEDICAL SERVICES INC.
Entity type:Organization
Organization Name:CHILDREN & ADOLESCENT MEDICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:P
Authorized Official - Last Name:CYRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-307-2273
Mailing Address - Street 1:8803 S. 101ST E. AVE.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133
Mailing Address - Country:US
Mailing Address - Phone:918-307-2273
Mailing Address - Fax:918-307-0273
Practice Address - Street 1:8803 S. 101ST E. AVE.
Practice Address - Street 2:SUITE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-307-2273
Practice Address - Fax:918-307-0273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100100600DMedicaid
OK200115550AMedicaid
OK100733310AMedicaid