Healthcare Provider Details

I. General information

NPI: 1487655627
Provider Name (Legal Business Name): UNION PINES SURGERY CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 S 109TH E AVE
TULSA OK
74146
US

IV. Provider business mailing address

4800 S 109TH E AVE
TULSA OK
74146
US

V. Phone/Fax

Practice location:
  • Phone: 918-742-2502
  • Fax: 918-745-9750
Mailing address:
  • Phone: 918-742-2502
  • Fax: 918-745-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0015
License Number StateOK

VIII. Authorized Official

Name: DR. SCOTT DUNITZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 918-742-2502