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General NPI Number Information
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NPI Number | 1083607360
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Entity Type | Organization
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Legal Business Name | EASTERN OKLAHOMA SURGERY CENTER LLC
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5020 E 68TH ST
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City | TULSA
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State | OK
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Zip | 74136-3307
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Country | US
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Telephone | 918-492-1539
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Fax | 918-523-4751
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Provider Business Mailing Address
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Address Line | 5020 E 68TH ST
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City | TULSA
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State | OK
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Zip | 74136-3307
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Country | US
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Telephone | 918-492-1539
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Fax | 918-523-4751
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES E HEINBERG
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Credential | MD
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Telephone | 918-492-1539
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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 | 0035
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License Number State | OK
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