Healthcare Provider Details

I. General information

NPI: 1083750525
Provider Name (Legal Business Name): SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 E 19TH ST SUITE 800
TULSA OK
74104-5472
US

IV. Provider business mailing address

PO BOX 35307
TULSA OK
74153-0307
US

V. Phone/Fax

Practice location:
  • Phone: 918-301-2505
  • Fax: 918-744-3633
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateOK

VIII. Authorized Official

Name: BETTY SLOAN
Title or Position: ASST OFFICE MANAGER
Credential:
Phone: 918-301-2505