Basic Information
| Provider Information | |||||||||
| NPI: | 1912936048 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ISMC SURGICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4401 S WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731093413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056367000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4401 S WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731093413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056367000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HUPFELD | ||||||||
| AuthorizedOfficialFirstName: | STANLEY | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4059493011 | ||||||||
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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 | 208600000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.