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General NPI Number Information
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NPI Number | 1962106013
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Entity Type | Organization
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Legal Business Name | SC ANESTHESIA LLC
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Dates
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Enumeration Date | 03/30/2023
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 2001 CRADDUCK RD
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City | ADA
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State | OK
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Zip | 74820-9400
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Country | US
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Telephone | 405-514-4786
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Fax | 405-758-5582
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Provider Business Mailing Address
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Address Line | 480 HICKORY HILL DR
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City | CHOCTAW
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State | OK
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Zip | 73020-7476
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Country | US
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Telephone | 405-514-4786
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Fax | 405-758-5354
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Authorized Official
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Title or Position | OWNER
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Name | GERALD JOSEPH
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Credential | CRNA
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Telephone | 405-514-4786
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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 |
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License Number State |
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