MEDICARE: SOUTHWEST AMBULATORY SURGERY CENTER, 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	261QA1903X	Ambulatory Surgical Clinic/Center	0034	OK

General Provider Information

NPI Number	:	1487750238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST AMBULATORY SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	8125 S WALKER AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9417
Country	:	US
Telephone Number	:	405-606-8890
Fax Number	:	405-631-1050

Provider Business Practice Location Address
First Line	:	8125 S. WALKER AVENUE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9476
Country	:	US
Telephone Number	:	405-602-6500
Fax Number	:	405-602-6597

Authorized Official
Title or Position	:	OFFICER / AUTHORIZED OFFICIAL
Name	:	NICHOLAS CRAFTS
Credential	:
Telephone Number	:	832-729-4009

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	05/16/2023

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