=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659313138
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOUNDATION BARIATRIC HOSPITAL OF OKLAHOMA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2006
-----------------------------------------------------
Last Update Date | 09/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 RENAISSANCE BLVD
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013-3023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-359-2400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 20485
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73156-0485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-359-2488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. CURTIS SUMMERS
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 405-359-2465
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 2370
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------