Healthcare Provider Details

I. General information

NPI: 1447392196
Provider Name (Legal Business Name): AMBULATORY SURGICAL CENTER OF TULSA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 E 15TH ST
TULSA OK
74104-4613
US

IV. Provider business mailing address

11999 SAN VICENTE BLVD STE,. 440
LOS ANGELES CA
90049-5131
US

V. Phone/Fax

Practice location:
  • Phone: 918-712-0888
  • Fax:
Mailing address:
  • Phone: 310-471-5852
  • Fax: 310-471-3958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GREG RATLIFF
Title or Position: OWNER
Credential: M.D.
Phone: 918-712-0888