Healthcare Provider Details

I. General information

NPI: 1477732568
Provider Name (Legal Business Name): SURGICAL SPECIALISTS OF OKLAHOMA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 09/19/2008
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 268848
OKLAHOMA CITY OK
73126-8848
US

V. Phone/Fax

Practice location:
  • Phone: 405-842-4850
  • Fax: 405-842-9612
Mailing address:
  • Phone: 405-842-4850
  • Fax: 405-842-9612

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: MR. DAVID F JOHNSON
Title or Position: CEO
Credential:
Phone: 405-842-4850