Healthcare Provider Details

I. General information

NPI: 1487644506
Provider Name (Legal Business Name): MCALESTER AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 E CLARK BASS BLVD
MCALESTER OK
74501-4269
US

IV. Provider business mailing address

PO BOX 966
MCALESTER OK
74502-0966
US

V. Phone/Fax

Practice location:
  • Phone: 918-421-6700
  • Fax: 918-421-6777
Mailing address:
  • Phone: 918-421-6700
  • Fax: 918-421-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0068
License Number StateOK

VIII. Authorized Official

Name: MR. DAVID KEITH
Title or Position: CEO
Credential:
Phone: 918-426-1800