Provider Demographics
NPI:1144527714
Name:STRAWBERRY HILL PEDIATRICS, P.C,
Entity type:Organization
Organization Name:STRAWBERRY HILL PEDIATRICS, P.C,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-622-1994
Mailing Address - Street 1:2227 S GARNETT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-5119
Mailing Address - Country:US
Mailing Address - Phone:918-622-1994
Mailing Address - Fax:918-270-1958
Practice Address - Street 1:2227 S GARNETT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-5115
Practice Address - Country:US
Practice Address - Phone:918-622-1994
Practice Address - Fax:918-270-1958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2099261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200421520AMedicaid