Healthcare Provider Details

I. General information

NPI: 1396984456
Provider Name (Legal Business Name): SURGICAL SPECIALISTS OF OKLAHOMA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 N THOMPKINS AVE
BETHANY OK
73008-5307
US

IV. Provider business mailing address

PO BOX 7570
EDMOND OK
73083-7570
US

V. Phone/Fax

Practice location:
  • Phone: 405-495-6134
  • Fax: 405-787-8466
Mailing address:
  • Phone: 405-842-4850
  • Fax: 405-242-2180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ANGELA COSBY
Title or Position: CEO
Credential:
Phone: 405-842-4850