Healthcare Provider Details

I. General information

NPI: 1659405280
Provider Name (Legal Business Name): CENTRAL OKLAHOMA ANESTHESIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LINCOLN BLVD SUITE 100
OKLAHOMA CITY OK
73104-3252
US

IV. Provider business mailing address

PO BOX 108809
OKLAHOMA CITY OK
73101-8809
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-9644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILIP MALONE
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 405-321-8125