Basic Information
| Provider Information | |||||||||
| NPI: | 1134714892 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OKLAHOMA ANESTHESIA SPECIALISTS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11105 KATIE BETH LN | ||||||||
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| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731708405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052266806 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 N ROCKWELL AVE | ||||||||
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| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731276112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057964242 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2021 | ||||||||
| LastUpdateDate: | 03/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | TRENT | ||||||||
| AuthorizedOfficialFirstName: | AUSTIN | ||||||||
| AuthorizedOfficialMiddleName: | GRAHAM | ||||||||
| AuthorizedOfficialTitleorPosition: | NURSE ANESTHESIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 4052266806 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
| NPICertificationDate: | 03/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.