Healthcare Provider Details

I. General information

NPI: 1346015310
Provider Name (Legal Business Name): SHO PROFESSIONAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 NW 63RD ST STE 201
OKLAHOMA CITY OK
73116-1937
US

IV. Provider business mailing address

3705 NW 63RD ST STE 201
OKLAHOMA CITY OK
73116-1937
US

V. Phone/Fax

Practice location:
  • Phone: 405-297-4968
  • Fax: 972-848-5269
Mailing address:
  • Phone: 405-297-4968
  • Fax: 972-848-5269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: HOLLIE N SEAGO
Title or Position: DIRECTOR/REVENUE CYCLE
Credential:
Phone: 972-846-0837