Healthcare Provider Details

I. General information

NPI: 1437652740
Provider Name (Legal Business Name): BNS ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2553 S KELLY AVE STE 110
EDMOND OK
73013-3890
US

IV. Provider business mailing address

2553 S KELLY AVE STE 100
EDMOND OK
73013-3894
US

V. Phone/Fax

Practice location:
  • Phone: 405-321-6984
  • Fax:
Mailing address:
  • Phone: 405-321-6984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number20680
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number199
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number22780
License Number StateOK

VIII. Authorized Official

Name: MARY SAMANTHA SPANN
Title or Position: MANAGER
Credential:
Phone: 405-321-6984