AHS OKLAHOMA PHYSICIAN GROUP, LLC (NPI# 1427112424) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427112424 |
| Entity Type | Organization |
| Organization Name | AHS OKLAHOMA PHYSICIAN GROUP, LLC |
| Other Organization Name | CHARITY POLLAK, MD OWASSO |
| Practice Address |
10512 N 110th E Ave Owasso OK 74055 |
| Mailing Address |
1145 S Utica Ave Suite 110 Tulsa OK 74104-4000 |
| Practice Telephone | 9182720114 |
| Practice Fax Number | 9182727475 |
| Mailing Telephone | 9185793825 |
| Mailing Fax Number | 9185791262 |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | ROBERT LANGLAND (CFO) |
| Authorized Official Telephone | 9185791000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Charity Pollak, MD Owasso | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821308248 | Ahs Oklahoma Physician Group, LLC | Family Medicine | 2400 N Highway 66 Ste B, Catoosa, OK 74015-3074 | 2010-10-19 |
| 1538366083 | Ahs Oklahoma Physician Group, LLC | Internal Medicine | 9245 South Mingo, Tulsa, OK 74133 | 2007-06-28 |
| 1578760021 | Ahs Oklahoma Physician Group, LLC | Pediatrics | 10512 North 110th E. Ave., Owasso, OK 74055 | 2007-06-28 |
| 1982729620 | Ahs Oklahoma Physician Group, LLC | Psychiatry & Neurology | 720 W 7th St, Tulsa, OK 74127-8948 | 2007-03-20 |
| 1891850137 | Ahs Oklahoma Physician Group, LLC | Family Medicine | 10512 N. 110th E. Ave., Owasso, OK 74055 | 2006-12-27 |
| 1588728836 | Ahs Oklahoma Physician Group, LLC | Family Medicine | 1551 N. 9th Street, Broken Arrow, OK 74012 | 2006-12-21 |
| 1710041009 | Ahs Oklahoma Physician Group, LLC | Nurse Practitioner | 2401 West Main, Henryetta, OK 74437 | 2006-12-20 |
| 1235293846 | Ahs Oklahoma Physician Group, LLC | Family Medicine | 300 Boulder St, Pawnee, OK 74058-3801 | 2006-12-20 |
| 1548324965 | Ahs Oklahoma Physician Group, LLC | Family Medicine | 4739 S Union Ave, Tulsa, OK 74107-7842 | 2006-12-20 |
| 1467836692 | Ahs Oklahoma Physician Group, LLC | Clinic/Center | 9245 S Mingo Rd, Tulsa, OK 74133-5793 | 2015-07-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | AHS OKLAHOMA PHYSICIAN GROUP, LLC | 1145 S Utica Ave Ste 115, Tulsa, OK 74104-4013 |
| Street Address |
10512 N 110TH E AVE |
| City | OWASSO |
| State | OK |
| Zip Code | 74055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477618379 | Ahs Oklahoma Physician Group, LLC | Pediatrics | 10512 N 110th E Ave, Owasso, OK 74055 | 2006-12-22 |
| 1548324890 | Ahs Oklahoma Physician Group, LLC | Pediatrics | 10512 N 110th E Ave, Owasso, OK 74055 | 2006-12-21 |
| 1205990488 | Ahs Oklahoma Physician Group, LLC | Pediatrics | 10512 N 110th E Ave, Owasso, OK 74055 | 2006-12-21 |
| 1467516336 | Ahs Oklahoma Physician Group, LLC | Family Medicine | 10512 N 110th E Ave, Owasso, OK 74055 | 2006-12-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972151587 | Lakecrest Dental-owasso 96th | Dentist | 9551 N. Owasso Expressway, Suite #100, Owasso, OK 74055 | 2019-08-27 |
| 1205328697 | Eddie Duane Gaut | Case Manager/Care Coordinator | 110 W 3rd St., Apt 11, Owasso, OK 74055 | 2018-06-01 |
| 1821586694 | Kaitlyn Konarik | Speech-Language Pathologist | 12899 E 76th St N, Ste. 109, Owasso, OH 74055 | 2018-04-27 |
| 1043733769 | Kelsey Renae Nicklas | Case Manager/Care Coordinator | 9310 N 163rd East Ave, Owasso, OK 74055 | 2017-07-25 |
| 1700259256 | Genscripts Owasso, LLC | Pharmacy | 9538 N Garnett Rd, Suite 102, Owasso, OK 74055 | 2015-11-05 |
| 1770968810 | Premier Anesthesia Management Inc | Clinic/Center | 19236 E Twin Creeks Dr, Owasso, OK 74055 | 2015-07-29 |
| 1598152407 | Justin Lum | Physical Therapist | 12326 E 86th St N, Owasso, OK 74055 | 2015-04-17 |
| 1033507660 | Kimberly Louise Howard | Physical Therapy Assistant | 12899 East 76th St North, Owasso, OK 74055 | 2015-01-06 |
| 1780920629 | Timothy Ryan Thornton | Behavioral Analyst | 11330 N 94 E Ave, Owasso, OK 74055 | 2012-12-21 |
| 1679842785 | Kelli Marie Ellis | Counselor | 19760 E Fox Run Cir, Owasso, OK 74055 | 2011-12-19 |
| Find all providers in zip 74055 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578760021 | Ahs Oklahoma Physician Group, LLC | Pediatrics | 10512 North 110th E. Ave., Owasso, OK 74055 | 2007-06-28 |
| 1225062516 | Christopher Fife Hebertson | Pediatrics | 12455 E 100th St N Ste 300, Owasso, OK 74055-4674 | 2006-07-10 |
| 1679501050 | Cheryl Ann Boyd | Pediatrics | 8439 N 117th East Ave, Owasso, OK 74055-2142 | 2006-06-28 |
| 1063945020 | Naga Sushma Chavvakula | Pediatrics | 13600 E 86th St N Ste 400, Owasso, OK 74055-8732 | 2017-04-06 |
| 1235497926 | Terri Okotoghaide Reed | Pediatrics | 12455 E 100th St N Ste 190, Owasso, OK 74055-4675 | 2012-05-01 |
| 1255538815 | Theresa Lynn Horton | Pediatrics | 10512 N 110th East Ave, Owasso, OK 74055-6636 | 2007-06-28 |
| 1417166802 | Childrens Clinic of Owasso | Pediatrics | 8439 N 117th East Ave, Owasso, OK 74055-2142 | 2007-05-22 |
| 1477618379 | Ahs Oklahoma Physician Group, LLC | Pediatrics | 10512 N 110th E Ave, Owasso, OK 74055 | 2006-12-22 |
| 1548324890 | Ahs Oklahoma Physician Group, LLC | Pediatrics | 10512 N 110th E Ave, Owasso, OK 74055 | 2006-12-21 |
| 1205990488 | Ahs Oklahoma Physician Group, LLC | Pediatrics | 10512 N 110th E Ave, Owasso, OK 74055 | 2006-12-21 |
| Find all providers in OWASSO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.