Basic Information
| Provider Information | |||||||||
| NPI: | 1023003035 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGICAL SPECIALISTS OF OKLAHOMA, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 W WILSHIRE BLVD | ||||||||
| Address2: | STE. 220 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731167030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058424850 | ||||||||
| FaxNumber: | 4058482425 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 W WILSHIRE BLVD | ||||||||
| Address2: | STE. 220 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731167030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058424850 | ||||||||
| FaxNumber: | 4058482425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4058424850 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.