PARK PLACE MEDICAL NPI 1114334885

NPI Information

  • NPI: 1114334885
  • Provider Name: PARK PLACE MEDICAL
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • CLIA Number: 37D0992423
  • Address: 500 PARK PL
    MUSTANG, OK
    ZIP 73064
  • Phone: (406) 376-5439

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NPI Details

PARK PLACE MEDICAL is a pediatrics in Mustang, OK. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. PARK PLACE MEDICAL NPI is 1114334885. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

500 PARK PL
MUSTANG, OK
ZIP 73064-104
Phone: (406) 376-5439
Fax: (405) 376-6459

The provider's authorized official is Donna Raye Cosby .
The authorized official title is Owner and has the following contact phone number (405) 376-5439.

The CLIA number assigned to this NPI record is 37D0992423 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/15/2014 and was last updated on 7/15/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatrics15742OKLAHOMAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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