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General NPI Number Information
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NPI Number | 1013298470
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Entity Type | Organization
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Legal Business Name | OKLAHOMA SURGICAL GROUP, PLLC
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 401 SW 80TH ST STE 101
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City | OKLAHOMA CITY
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State | OK
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Zip | 73139-8123
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Country | US
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Telephone | 405-286-9465
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Fax | 405-286-9462
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Provider Business Mailing Address
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Address Line | PO BOX 6370
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City | EDMOND
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State | OK
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Zip | 73083-6370
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Country | US
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Telephone | 405-312-3038
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KRISTIE A FOSTER
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Credential |
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Telephone | 405-312-3038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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