MEDICARE: SURGICAL SPECIALISTS OF OKLAHOMA PLLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1265596969	OTHER	OK	NPI

General Provider Information

NPI Number	:	1902085087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL SPECIALISTS OF OKLAHOMA PLLC

Provider Business Mailing Address
First Line	:	PO BOX 7570
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73083-7570
Country	:	US
Telephone Number	:	405-842-4850
Fax Number	:	405-242-2180

Provider Business Practice Location Address
First Line	:	5300 N GRAND BLVD
Second Line	:	STE 200
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5647
Country	:	US
Telephone Number	:	405-842-4850
Fax Number	:	405-242-2180

Authorized Official
Title or Position	:	CEO
Name	:	MRS. ANGELA COSBY
Credential	:
Telephone Number	:	405-842-4850

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	12/03/2009

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