Healthcare Provider Details

I. General information

NPI: 1942292073
Provider Name (Legal Business Name): SOUTHERN OKLAHOMA SURGICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 NORTH COMMERCE
ARDMORE OK
73401-1356
US

IV. Provider business mailing address

2412 NORTH COMMERCE
ARDMORE OK
73401-1356
US

V. Phone/Fax

Practice location:
  • Phone: 580-226-5000
  • Fax: 580-226-5035
Mailing address:
  • Phone: 580-226-5000
  • Fax: 580-226-5035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0023
License Number StateOK

VIII. Authorized Official

Name: CHRISTY MORRIS
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 580-226-5000