Healthcare Provider Details

I. General information

NPI: 1003800798
Provider Name (Legal Business Name): SURGERY CENTER OF MIDWEST CITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8121 NATIONAL AVE SUITE 108
MIDWEST CITY OK
73110-7530
US

IV. Provider business mailing address

8121 NATIONAL AVE SUITE 108
MIDWEST CITY OK
73110-7530
US

V. Phone/Fax

Practice location:
  • Phone: 405-732-7905
  • Fax: 405-741-4622
Mailing address:
  • Phone: 405-732-7905
  • Fax: 405-741-4622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0025
License Number StateOK

VIII. Authorized Official

Name: MRS. SHERRY MILLS
Title or Position: ADMINISTRATOR
Credential: RN,BSN
Phone: 405-732-7905