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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1245419340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL SPECIALISTS OF OKLAHOMA PLLC

Provider Business Mailing Address
First Line	:	1000 W WILSHIRE BLVD
Second Line	:	SUITE 220
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-7030
Country	:	US
Telephone Number	:	405-842-4850
Fax Number	:	405-842-9612

Provider Business Practice Location Address
First Line	:	3705 NW 63RD ST
Second Line	:	STE 201
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1935
Country	:	US
Telephone Number	:	405-242-2101
Fax Number	:	405-842-9612

Authorized Official
Title or Position	:	CEO
Name	:	MR. DAVID F JOHNSON
Credential	:
Telephone Number	:	405-842-4850

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	10/25/2007

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