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General NPI Number Information
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NPI Number | 1487644506
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Entity Type | Organization
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Legal Business Name | MCALESTER AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 4 E CLARK BASS BLVD
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City | MCALESTER
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State | OK
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Zip | 74501-4269
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Country | US
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Telephone | 918-421-6700
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Fax | 918-421-6777
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Provider Business Mailing Address
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Address Line | PO BOX 966
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City | MCALESTER
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State | OK
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Zip | 74502-0966
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Country | US
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Telephone | 918-421-6700
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Fax | 918-421-6777
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Authorized Official
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Title or Position | CEO
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Name | MR. DAVID KEITH
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Credential |
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Telephone | 918-426-1800
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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 | 0068
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License Number State | OK
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