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General NPI Number Information
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NPI Number | 1750597449
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Entity Type | Organization
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Legal Business Name | OKLAHOMA LITHOTRIPTER ASSOCIATES, L.C.
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5401 N PORTLAND AVE STE 650
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-2081
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Country | US
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Telephone | 405-604-4160
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Fax | 405-604-4053
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Provider Business Mailing Address
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Address Line | 5401 N PORTLAND AVE STE 640
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-2130
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Country | US
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Telephone | 405-604-4160
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Fax | 405-604-4053
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Authorized Official
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Title or Position | EXECUTIVE DIR
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Name | STEWART C BURCHETT
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Credential |
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Telephone | 405-604-4183
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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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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 0086
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License Number State | OK
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