Healthcare Provider Details

I. General information

NPI: 1801252952
Provider Name (Legal Business Name): ANESTHESIA SPECIALISTS OF OKLAHOMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 NE 3RD ST
OKLAHOMA CITY OK
73104-2205
US

IV. Provider business mailing address

PO BOX 6971
LINCOLN NE
68506-0971
US

V. Phone/Fax

Practice location:
  • Phone: 405-823-2491
  • Fax: 402-434-6047
Mailing address:
  • Phone: 402-486-7040
  • Fax: 402-434-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR0100377
License Number StateOK

VIII. Authorized Official

Name: TODD M FOGARTY
Title or Position: MANAGING MEMBER
Credential: APRN-CRNA
Phone: 405-823-2491