MEDICARE: FOUNDATION BARIATRIC HOSPITAL OF OKLAHOMA, 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	2370	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000370225001	OTHER	OK	BC/BS PROVIDER NUMBER

General Provider Information

NPI Number	:	1659313138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATION BARIATRIC HOSPITAL OF OKLAHOMA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 20485
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73156-0485
Country	:	US
Telephone Number	:	405-359-2488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 RENAISSANCE BLVD
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-3023
Country	:	US
Telephone Number	:	405-359-2400
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CURTIS SUMMERS
Credential	:	MBA
Telephone Number	:	405-359-2465

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	09/10/2008

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