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General NPI Number Information
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NPI Number | 1659943157
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Entity Type | Organization
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Legal Business Name | HEALTHCREST SURGICAL MANAGEMENT, LLC
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Dates
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Enumeration Date | 07/14/2021
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 3540 S BOULEVARD STE 225
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City | EDMOND
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State | OK
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Zip | 73013-5569
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Country | US
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Telephone | 405-697-2420
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Fax | 405-697-2470
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Provider Business Mailing Address
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Address Line | 3540 S BOULEVARD STE 225
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City | EDMOND
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State | OK
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Zip | 73013-5569
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Country | US
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Telephone | 405-697-2420
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Fax | 405-697-2470
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Authorized Official
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Title or Position | VP, MANAGED CARE CONTRACTING
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Name | TRISHA GRUS
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Credential |
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Telephone | 405-697-2420
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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 |
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License Number State |
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