MEDICARE: THE OKLAHOMA CITY ASC 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	0057	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	490003867	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134191331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE OKLAHOMA CITY ASC LLC

Provider Business Mailing Address
First Line	:	13313 N MERIDIAN AVE
Second Line	:	BUILDING B
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8316
Country	:	US
Telephone Number	:	405-755-4140
Fax Number	:	405-755-4072

Provider Business Practice Location Address
First Line	:	13313 N MERIDIAN AVE
Second Line	:	BUILDING B
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8316
Country	:	US
Telephone Number	:	405-755-4140
Fax Number	:	405-755-4072

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PHILLIP A CLENDENIN
Credential	:
Telephone Number	:	615-665-1283

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	09/07/2023

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Directions to “THE OKLAHOMA CITY ASC LLC ” Practice Location

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