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General NPI Number Information
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NPI Number | 1801252952
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Entity Type | Organization
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Legal Business Name | ANESTHESIA SPECIALISTS OF OKLAHOMA LLC
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Dates
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Enumeration Date | 01/05/2016
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Last Update Date | 09/08/2022
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Provider Practice Location Address
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Address Line | 21 NE 3RD ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-2205
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Country | US
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Telephone | 405-823-2491
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Fax | 402-434-6047
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Provider Business Mailing Address
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Address Line | PO BOX 6971
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City | LINCOLN
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State | NE
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Zip | 68506-0971
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Country | US
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Telephone | 402-486-7040
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Fax | 402-434-6047
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | TODD M FOGARTY
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Credential | APRN-CRNA
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Telephone | 405-823-2491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R0100377
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License Number State | OK
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