Healthcare Provider Details

I. General information

NPI: 1366814121
Provider Name (Legal Business Name): SMART SINUS OK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13908 QUAILBROOK DR QUAILBROOK BULDG C
OKLAHOMA CITY OK
73134-1718
US

IV. Provider business mailing address

13908 QUAILBROOK DR QUAILBROOK MEDICAL CENTER BLDG C
OKLAHOMA CITY OK
73134-1718
US

V. Phone/Fax

Practice location:
  • Phone: 405-479-8625
  • Fax: 405-479-8627
Mailing address:
  • Phone: 405-479-8625
  • Fax: 405-479-8627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number03612239
License Number StateIL

VIII. Authorized Official

Name: BOSE OSHIN
Title or Position: BILLING MANAGER
Credential:
Phone: 847-278-1885