MEDICARE: INTRAOPERATIVE MONITORING SERVICES, 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	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1386778140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTRAOPERATIVE MONITORING SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 616
Second Line	:
City	:	JENKS
State	:	OK
Zip	:	74037-0616
Country	:	US
Telephone Number	:	918-936-4295
Fax Number	:	918-926-3688

Provider Business Practice Location Address
First Line	:	2128 S ATLANTA PLACE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-1771
Country	:	US
Telephone Number	:	918-477-5950
Fax Number	:

Authorized Official
Title or Position	:	CONTACT PERSON
Name	:	SHON HUGHES
Credential	:
Telephone Number	:	918-477-5950

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/13/2021

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