Healthcare Provider Details

I. General information

NPI: 1508045675
Provider Name (Legal Business Name): SURGICAL SPECIALISTS OF OKLAHOMA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 W MEMORIAL RD STE 422
OKLAHOMA CITY OK
73120-8366
US

IV. Provider business mailing address

PO BOX 7570
EDMOND OK
73083-7570
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-0051
  • Fax:
Mailing address:
  • Phone: 405-842-4850
  • Fax: 405-242-2180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA COSBY
Title or Position: CEO
Credential:
Phone: 405-842-4850