MEDICARE: GP SURGERY CENTER, 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	0027	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	490005778	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
3	000371019001	OTHER	OK	BLUE CROSS PROVIDER NUMBE
4	000371019001	OTHER		BLUE CROSS

General Provider Information

NPI Number	:	1477551745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GP SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	5404 SOUTHWEST LEE BOULEVARD
Second Line	:	SUITE 100
City	:	LAWTON
State	:	OK
Zip	:	73505-9521
Country	:	US
Telephone Number	:	580-536-7533
Fax Number	:	580-536-7535

Provider Business Practice Location Address
First Line	:	5404 SOUTHWEST LEE BOULEVARD
Second Line	:	SUITE 100
City	:	LAWTON
State	:	OK
Zip	:	73505-9521
Country	:	US
Telephone Number	:	580-536-7533
Fax Number	:	580-536-7535

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	KATHERINE L. REED
Credential	:
Telephone Number	:	972-763-3859

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	11/19/2009

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Directions to “GP SURGERY CENTER, LLC ” Practice Location

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