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NPI Code Detail

MEDICARE: SURGICAL SPECIALISTS OF OKLAHOMA, PLLC

MEDICARE: SURGICAL SPECIALISTS OF OKLAHOMA, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11275508186OTHEROKNPI
21043286776OTHEROKNPI

General Provider Information

NPI Number : 1134376445
Entity Type Code : Organization
Provider Name (Legal Business Name) : SURGICAL SPECIALISTS OF OKLAHOMA, PLLC
Provider Business Mailing Address
First Line : PO BOX 7570
Second Line :
City : EDMOND
State : OK
Zip : 73083-7570
Country : US
Telephone Number : 405-842-4850
Fax Number : 405-242-2180
Provider Business Practice Location Address
First Line : 3705 NW 63RD ST
Second Line : STE. 204
City : OKLAHOMA CITY
State : OK
Zip : 73116-1935
Country : US
Telephone Number : 405-942-7841
Fax Number : 405-608-4239
Authorized Official
Title or Position : CEO
Name : MRS. ANGELA COSBY
Credential :
Telephone Number : 405-842-4850
Provider Enumeration Date : 08/19/2008
Last Update Date : 12/03/2009

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