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General NPI Number Information
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NPI Number | 1629371687
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Entity Type | Organization
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Legal Business Name | GREATER NORMAN SURGERY CENTER, LLC
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Dates
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Enumeration Date | 12/14/2010
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 3400 W TECUMSEH RD SUITE 301
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City | NORMAN
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State | OK
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Zip | 73072-1810
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Country | US
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Telephone | 855-395-1086
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 258816
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City | OKLAHOMA CITY
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State | OK
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Zip | 73125-8816
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Country | US
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Telephone | 855-395-1086
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DONNA DRERUP
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Credential |
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Telephone | 855-395-1086
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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 | 0094
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License Number State | OK
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