MEDICARE: SURE GAS LLC

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	367500000X	Certified Registered Nurse Anesthetist	R0053020	OK

General Provider Information

NPI Number	:	1275999831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURE GAS LLC

Provider Business Mailing Address
First Line	:	419 W GRAY ST
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73069-7117
Country	:	US
Telephone Number	:	405-329-7300
Fax Number	:	405-364-5379

Provider Business Practice Location Address
First Line	:	8121 NATIONAL AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73110-7530
Country	:	US
Telephone Number	:	405-732-7905
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MARK A WILLIAMS
Credential	:	APRN-CRNA
Telephone Number	:	405-514-0014

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	01/12/2016

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Directions to “SURE GAS LLC ” Practice Location

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