Healthcare Provider Details

I. General information

NPI: 1013298470
Provider Name (Legal Business Name): OKLAHOMA SURGICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SW 80TH ST STE 101
OKLAHOMA CITY OK
73139-8123
US

IV. Provider business mailing address

PO BOX 6370
EDMOND OK
73083-6370
US

V. Phone/Fax

Practice location:
  • Phone: 405-286-9465
  • Fax: 405-286-9462
Mailing address:
  • Phone: 405-312-3038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTIE A FOSTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 405-312-3038