Healthcare Provider Details

I. General information

NPI: 1174997753
Provider Name (Legal Business Name): ANESTHESIA PARTNERS OF OKLAHOMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 S WALKER AVE BLDG C
OKLAHOMA CITY OK
73139-9402
US

IV. Provider business mailing address

8100 S WALKER AVE BLDG. C
OKLAHOMA CITY OK
73139-9402
US

V. Phone/Fax

Practice location:
  • Phone: 405-602-6500
  • Fax:
Mailing address:
  • Phone: 405-602-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL T KIMZEY
Title or Position: ADMINISTRATOR/AUTHORIZED OFFICIAL
Credential:
Phone: 405-602-6500