Healthcare Provider Details

I. General information

NPI: 1366499188
Provider Name (Legal Business Name): ADVANCED COLORECTAL ASSOCIATES L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W MEMORIAL RD STE 612
OKLAHOMA CITY OK
73120-8387
US

IV. Provider business mailing address

4200 W MEMORIAL RD STE 612
OKLAHOMA CITY OK
73120-8387
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-4201
  • Fax: 405-749-4208
Mailing address:
  • Phone: 405-749-4201
  • Fax: 405-749-4208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberDR. SAHA'S -22328
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberDR. WOODWARD'S-6976
License Number StateOK

VIII. Authorized Official

Name: MRS. URVASHI SANGHAVI-SAHA
Title or Position: OFFICE MANAGER
Credential: M.S.
Phone: 405-749-4201