Healthcare Provider Details

I. General information

NPI: 1235785593
Provider Name (Legal Business Name): OKLAHOMA COMMONS SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 E 15TH ST
TULSA OK
74104-4611
US

IV. Provider business mailing address

1844 E 15TH ST
TULSA OK
74104-4611
US

V. Phone/Fax

Practice location:
  • Phone: 918-218-2041
  • Fax: 405-509-7079
Mailing address:
  • Phone: 918-218-2041
  • Fax: 405-509-7079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. FAY E WELLS
Title or Position: DEVELOPMENT COORDINATOR
Credential:
Phone: 405-623-7743