Healthcare Provider Details

I. General information

NPI: 1457410300
Provider Name (Legal Business Name): METRO ANESTHESIA CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14101 PARKWAY COMMONS DR
OKLAHOMA CITY OK
73134-6012
US

IV. Provider business mailing address

PO BOX 960077
OKLAHOMA CITY OK
73196-0001
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-2765
  • Fax: 405-749-2766
Mailing address:
  • Phone: 405-749-2765
  • Fax: 405-749-2766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number13034
License Number StateOK

VIII. Authorized Official

Name: STEPHEN A ANDRADE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 405-749-2765