MEDICARE: SOUTHERN OKLAHOMA SURGICAL CENTER 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	261QA1903X	Ambulatory Surgical Clinic/Center	0023	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	490000424	OTHER	OK	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000371010001	OTHER	OK	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942292073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN OKLAHOMA SURGICAL CENTER INC

Provider Business Mailing Address
First Line	:	2412 NORTH COMMERCE
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-1356
Country	:	US
Telephone Number	:	580-226-5000
Fax Number	:	580-226-5035

Provider Business Practice Location Address
First Line	:	2412 NORTH COMMERCE
Second Line	:
City	:	ARDMORE
State	:	OK
Zip	:	73401-1356
Country	:	US
Telephone Number	:	580-226-5000
Fax Number	:	580-226-5035

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CHRISTY MORRIS
Credential	:	RN
Telephone Number	:	580-226-5000

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	11/18/2008

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