=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386892230
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORMAN ENDOSCOPY CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2008
-----------------------------------------------------
Last Update Date | 10/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 N PORTER AVE STE 100
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73071-6650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-366-0969
-----------------------------------------------------
Fax | 405-366-1839
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1125 N PORTER AVE SUITE 206
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73071-6446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-366-8619
-----------------------------------------------------
Fax | 405-366-1839
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MARKET PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT HOLBROOK
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 405-366-8619
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------