MEDICARE: OKLAHOMA SURGICAL HOSPITAL, 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	282N00000X	General Acute Care Hospital	2350	OK

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	:	1487651857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA SURGICAL HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	2408 E 81ST ST
Second Line	:	STE 900
City	:	TULSA
State	:	OK
Zip	:	74137-4217
Country	:	US
Telephone Number	:	918-477-5100
Fax Number	:	918-477-5930

Provider Business Practice Location Address
First Line	:	2408 E 81ST ST
Second Line	:	STE 900
City	:	TULSA
State	:	OK
Zip	:	74137-4217
Country	:	US
Telephone Number	:	918-477-5100
Fax Number	:	918-477-5930

Authorized Official
Title or Position	:	CEO
Name	:	RICK FERGUSON
Credential	:
Telephone Number	:	918-477-5049

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	08/08/2008

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Practice Location Address:

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1568467504 — DR. DEBORIA FRANCES GILL D.D.S.
Practice Location Address:

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