Healthcare Provider Details

I. General information

NPI: 1770968810
Provider Name (Legal Business Name): PREMIER ANESTHESIA MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/21/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 E 41ST ST STE 801
TULSA OK
74135-5630
US

IV. Provider business mailing address

PO BOX 1043
OWASSO OK
74055-1043
US

V. Phone/Fax

Practice location:
  • Phone: 918-504-9686
  • Fax:
Mailing address:
  • Phone: 918-504-9686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateOK

VIII. Authorized Official

Name: DANIEL HEATH RAGSDALE
Title or Position: DIRECTOR
Credential: CRNA
Phone: 918-504-9686