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General NPI Number Information
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NPI Number | 1093792681
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Entity Type | Organization
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Legal Business Name | COSMETIC SURGERY CENTER OF ARDMORE LLC
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 818 16TH AVE NW
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City | ARDMORE
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State | OK
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Zip | 73401-1818
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Country | US
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Telephone | 580-226-2171
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Fax | 580-226-2772
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Provider Business Mailing Address
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Address Line | 818 16TH AVE NW
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City | ARDMORE
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State | OK
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Zip | 73401-1818
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Country | US
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Telephone | 580-226-2171
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Fax | 580-226-2772
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Authorized Official
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Title or Position | OWNER
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Name | DR. HARRY GALOOB
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Credential | M.D.
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Telephone | 580-226-2171
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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 |
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License Number State |
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