Healthcare Provider Details

I. General information

NPI: 1881159085
Provider Name (Legal Business Name): SMALL GROUP ANESTHESIA SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4716 W URBANA ST
BROKEN ARROW OK
74012-5997
US

IV. Provider business mailing address

7362 N 195TH EAST AVE
OWASSO OK
74055-8219
US

V. Phone/Fax

Practice location:
  • Phone: 918-704-5556
  • Fax:
Mailing address:
  • Phone: 918-704-5556
  • Fax: 866-550-2242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name: MORGAN LEA MORGAN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 918-770-2900