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NPI Code Detail

MEDICARE: UNION PINES SURGERY CENTER,LLC

MEDICARE: UNION PINES 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
1261QA1903XAmbulatory Surgical Clinic/Center0015OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18471141OTHEROKAETNA
2000371001 002OTHEROKBC/BS

General Provider Information

NPI Number : 1487655627
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNION PINES SURGERY CENTER,LLC
Provider Business Mailing Address
First Line : 4808 S 109TH EAST AVE
Second Line :
City : TULSA
State : OK
Zip : 74146-5822
Country : US
Telephone Number : 918-742-2502
Fax Number : 918-745-9750
Provider Business Practice Location Address
First Line : 4808 S 109TH EAST AVE
Second Line :
City : TULSA
State : OK
Zip : 74146-5822
Country : US
Telephone Number : 918-742-2502
Fax Number : 918-745-9750
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : WESLEY STOTLER
Credential : DO
Telephone Number : 918-742-1457
Provider Enumeration Date : 08/10/2005
Last Update Date : 02/16/2026

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Directions to “UNION PINES SURGERY CENTER,LLC ” Practice Location

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