KICKINGBIRD FAMILY MEDICINE PLLC (NPI# 1699963264) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699963264 |
| Entity Type | Organization |
| Organization Name | KICKINGBIRD FAMILY MEDICINE PLLC |
| Other Organization Name | COFFEE CREEK MEDICAL CLINIC |
| Practice Address |
2820 N Kelly Ave Suite 200 Edmond OK 73003-3007 |
| Mailing Address |
Po Box 31266 Edmond OK 73003-0022 |
| Practice Telephone | 4053301478 |
| Practice Fax Number | 4053306231 |
| Mailing Telephone | 4053301478 |
| Mailing Fax Number | 4053306231 |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2008-02-04 |
| Authorized Official Name | DR. TIMOTHY BRIAN JONES (OWNER) |
| Authorized Official Telephone | 4053301478 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Coffee Creek Medical Clinic | Doing Business As Name - Organization |
| Street Address |
2820 N KELLY AVE SUITE 200 |
| City | EDMOND |
| State | OK |
| Zip Code | 73003-3007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164482501 | Kimberly Edgmon | Pediatrics | 2820 N Kelly Ave, Suite 200, Edmond, OK 73003-3007 | 2006-03-27 |
| 1831556612 | Kimberly Edgmon Md, Pllc | Pediatrics | 2820 N Kelly Ave, Suite 200, Edmond, OK 73003-3007 | 2016-01-25 |
| 1548505258 | Edmond Pediatrics | Pediatrics | 2820 N Kelly Ave, Suite 100, Edmond, OK 73003-3007 | 2012-12-06 |
| 1306160627 | Tammy Maschino, Md Pllc | Pediatrics | 2820 N Kelly Ave, Suite 200, Edmond, OK 73003-3007 | 2010-03-15 |
| 1679739155 | Zann Mcmahan Md PC | Family Medicine | 2820 N Kelly Ave, Suite #200, Edmond, OK 73003-3007 | 2008-08-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945202 | Korbin Hally | Dentist | 2600 Tayler Street, Edmond, OK 73003 | 2020-06-04 |
| 1003448325 | Diagnostic Resources, LLC | Physical Medicine & Rehabilitation | 1641 Saratoga Way, Edmond, OK 73003 | 2020-02-05 |
| 1861904021 | Rhonda Diane Pennington | Occupational Therapist | 515 S Santa Fe Ave Ste 103, Edmond, OK 73003 | 2017-10-27 |
| 1588173744 | Hpc Holdings LLC | Clinic/Center | 813 W Covell Rd, Edmond, OK 73003 | 2017-09-20 |
| 1194243568 | Nightengale Chiropractic, LLC | Chiropractor | 2616 Covell Village Dr Ste. 120, Edmond, OK 73003 | 2017-09-06 |
| 1104274927 | Bonsu Osei Asibey | Case Manager/Care Coordinator | 1301 Craig Blvd, Edmond, OK 73003 | 2016-06-02 |
| 1215390810 | Prince Yebo | Case Manager/Care Coordinator | 1817 Redland Dr, Edmond, OK 73003 | 2016-03-31 |
| 1548621691 | Charles Loftis | Physical Therapist | 1321 Fretz Drive, 100, Edmond, OK 73003 | 2016-03-17 |
| 1487013801 | Courage Counseling Center | Community/Behavioral Health | 1400 S. Fretz Ave, Suite 1400, Edmond, OK 73003 | 2016-02-12 |
| 1669889887 | Shannon Gogel | Occupational Therapy Assistant | 1309 Val Genes Rd, Edmond, OK 73003 | 2014-07-21 |
| Find all providers in zip 73003 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811459191 | Peak Movement Centre, Pllc | Clinic/Center | 13816 Santa Fe Crossing Dr, Edmond, OK 73013 | 2019-04-04 |
| 1285109876 | Housecall Providers of Oklahoma LLC | Clinic/Center | 1701 Victoria Dr, Edmond, OK 73003-3860 | 2018-10-10 |
| 1497038327 | Board of Regents of The University of Oklahoma-ou Physicians | Clinic/Center | 14101 N Eastern Avenue, Edmond, OK 73013 | 2011-09-27 |
| 1629381215 | Integrated Focus | Clinic/Center | 112 W 10th Pl, Edmond, OK 73003-5755 | 2010-07-23 |
| 1740383603 | Board of Regents of The Univ of Oklahoma-ou Phys Edmond Clinic | Clinic/Center | 105 N Bryant, Suite 305, Edmond, OK 73034 | 2006-09-06 |
| 1598195547 | Key Health Institute of Edmond, LLC | Clinic/Center | 14701 N Kelly Ave, Edmond, OK 73013-3814 | 2013-11-12 |
| 1093940454 | Family Medicine Associates of Edmond LLC | Clinic/Center | 105 S Bryant Ave Ste 210, Edmond, OK 73034-6331 | 2009-05-28 |
| 1033362231 | Edmond Podiatry Associates LLC | Clinic/Center | 105 S Bryant Ave Ste 104, Edmond, OK 73034-6361 | 2008-10-31 |
| 1780801274 | Board of Regents of The University of Oklahoma - Ou Physicians Hope | Clinic/Center | 1251 N Broadway, Edmond, OK 73034-3616 | 2007-04-19 |
| 1821121930 | Oklahoma Christian University | Clinic/Center | 2501 E Memorial Rd, Edmond, OK 73013-5525 | 2007-03-14 |
| Find all providers in EDMOND | ||||
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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.