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NPI Code Detail

MEDICARE: ZACKER ANESTHESIA SERVICE PC

MEDICARE: ZACKER ANESTHESIA SERVICE PC
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
1207L00000XAnesthesiology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DG2083OTHEROKRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1611997100OTHEROKDEPT OF LABOR
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639270697
Entity Type Code : Organization
Provider Name (Legal Business Name) : ZACKER ANESTHESIA SERVICE PC
Provider Business Mailing Address
First Line : PO BOX 1547
Second Line :
City : SEDALIA
State : MO
Zip : 65302-1547
Country : US
Telephone Number : 660-826-5960
Fax Number : 660-826-4852
Provider Business Practice Location Address
First Line : 3100 SW 89TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73159-7900
Country : US
Telephone Number : 405-602-8100
Fax Number :
Authorized Official
Title or Position : OWNER
Name : STEPHEN P ZACKER
Credential : MD
Telephone Number : 405-602-8100
Provider Enumeration Date : 09/25/2006
Last Update Date : 07/21/2022

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1619937406 — PHILLIP G DOERNER MD
Practice Location Address:
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OKLAHOMA CITY, OK
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1861421273 — DR. STEPHEN P ZACKER MD
Practice Location Address:
3100 SW 89TH ST
OKLAHOMA CITY, OK
73159-7900
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Practice Fax:
1831238138 — KATHY DIANE JOHNSON-TURNER D.O.
Practice Location Address:
3100 SW 89TH ST
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Practice Fax:

Directions to “ZACKER ANESTHESIA SERVICE PC ” Practice Location

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