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General NPI Number Information
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NPI Number | 1306827464
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Entity Type | Organization
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Legal Business Name | OKLAHOMA SURGERY AND UROLOGY CENTER
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5401 N PORTLAND AVE SUITE 100
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-2082
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Country | US
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Telephone | 405-604-4194
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Fax | 405-604-4902
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Provider Business Mailing Address
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Address Line | 5401 N PORTLAND AVE SUITE 110
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-2082
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Country | US
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Telephone | 405-604-4194
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Fax | 405-604-4902
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. ANNA MARIE LEE
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Credential | R.N.
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Telephone | 405-604-4194
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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 | 0050
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License Number State | OK
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