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General NPI Number Information
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NPI Number | 1376709907
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Entity Type | Organization
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Legal Business Name | ARDMORE REGIONAL SURGERY CENTER, LLC
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 08/04/2008
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Provider Practice Location Address
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Address Line | 2002 12TH AVE NW SUITE C
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City | ARDMORE
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State | OK
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Zip | 73401-1227
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Country | US
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Telephone | 580-224-0007
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Fax | 580-223-7140
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Provider Business Mailing Address
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Address Line | 2002 12TH AVE NW SUITE C
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City | ARDMORE
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State | OK
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Zip | 73401-1227
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Country | US
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Telephone | 580-224-0007
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SALLY A GODFREY
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Credential | CASC
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Telephone | 580-224-0007
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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 | 0064
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License Number State | OK
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