Healthcare Provider Details

I. General information

NPI: 1245093699
Provider Name (Legal Business Name): SOUTH TULSA PLASTIC SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S GATEWAY PL STE 202
JENKS OK
74037
US

IV. Provider business mailing address

224 S GATEWAY PL STE 202
JENKS OK
74037
US

V. Phone/Fax

Practice location:
  • Phone: 918-518-5144
  • Fax: 918-921-8155
Mailing address:
  • Phone: 918-200-5454
  • Fax: 918-921-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BRENDA SCHIESEL
Title or Position: PRIMARY OWNER/MEDICAL DIRECTOR
Credential: DO
Phone: 918-200-5454