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General NPI Number Information
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NPI Number | 1073570552
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Entity Type | Organization
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Legal Business Name | PHYSICIANS SURGICAL CENTER LLC
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 3121 S TELEPHONE RD
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City | MOORE
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State | OK
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Zip | 73160-2944
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Country | US
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Telephone | 405-364-9789
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Fax | 405-447-4985
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Provider Business Mailing Address
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Address Line | 3121 S TELEPHONE RD
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City | MOORE
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State | OK
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Zip | 73160-2944
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Country | US
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Telephone | 405-364-9789
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Fax | 405-447-4985
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RHONDA WALLACE
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Credential |
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Telephone | 405-364-9789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 0022
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License Number State | OK
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