MEDICARE: MOONLIGHT ANESTHESIA CONSULTING INC

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	207L00000X	Anesthesiology Physician

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	:	1669116455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOONLIGHT ANESTHESIA CONSULTING INC

Provider Business Mailing Address
First Line	:	2115 BELLAIRE DR
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-4206
Country	:	US
Telephone Number	:	405-213-5351
Fax Number	:

Provider Business Practice Location Address
First Line	:	3705 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1935
Country	:	US
Telephone Number	:	405-213-5351
Fax Number	:

Authorized Official
Title or Position	:	CRNA
Name	:	TRACI WILMARTH
Credential	:	CRNA
Telephone Number	:	405-213-5351

Provider Enumeration Date	:	04/26/2022
Last Update Date	:	04/26/2022

Similar Medicare Providers

1417955063 — CLINTON BRADSHAW WEBSTER M.D.
Practice Location Address:

3705 NW 63RD ST , SUITE 204
OKLAHOMA CITY, OK
73116-1935

Practice Phone: 405-842-9732
Practice Fax: 405-842-9771

1245419340 — SURGICAL SPECIALISTS OF OKLAHOMA PLLC
Practice Location Address:

3705 NW 63RD ST , STE 201
OKLAHOMA CITY, OK
73116-1935

Practice Phone: 405-242-2101
Practice Fax: 405-842-9612

1134376445 — SURGICAL SPECIALISTS OF OKLAHOMA, PLLC
Practice Location Address:

3705 NW 63RD ST , STE. 204
OKLAHOMA CITY, OK
73116-1935

Practice Phone: 405-942-7841
Practice Fax: 405-608-4239

1861624074 — TULSA ONLY CHOICE INC
Practice Location Address:

3705 NW 63RD ST , SUITE 101
OKLAHOMA CITY, OK
73116-1935

Practice Phone: 405-708-5292
Practice Fax: 918-512-4199

1063707875 — PRO THERAPY SERVICES LLC
Practice Location Address:

3705 NW 63RD ST , SUITE 208
OKLAHOMA CITY, OK
73116-1935

Practice Phone: 405-608-4308
Practice Fax:

1922446780 — CLINTON WEBSTER MD PC
Practice Location Address:

3705 NW 63RD ST , SUITE 204
OKLAHOMA CITY, OK
73116-1935

Practice Phone: 405-842-9732
Practice Fax: 405-842-9771

Directions to “MOONLIGHT ANESTHESIA CONSULTING INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.