MEDICARE: SURGERY CENTER OF MIDWEST CITY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	0025	OK

General Provider Information

NPI Number	:	1003800798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGERY CENTER OF MIDWEST CITY, LLC

Provider Business Mailing Address
First Line	:	8121 NATIONAL AVE
Second Line	:	SUITE 108
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7530
Country	:	US
Telephone Number	:	405-732-7905
Fax Number	:	405-741-4622

Provider Business Practice Location Address
First Line	:	8121 NATIONAL AVE
Second Line	:	SUITE 108
City	:	MIDWEST CITY
State	:	OK
Zip	:	73110-7530
Country	:	US
Telephone Number	:	405-732-7905
Fax Number	:	405-741-4622

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. SHERRY MILLS
Credential	:	RN,BSN
Telephone Number	:	405-732-7905

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	04/10/2014

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