Provider Demographics
NPI:1003800798
Name:SURGERY CENTER OF MIDWEST CITY, LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF MIDWEST CITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:405-732-7905
Mailing Address - Street 1:8121 NATIONAL AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7530
Mailing Address - Country:US
Mailing Address - Phone:405-732-7905
Mailing Address - Fax:405-741-4622
Practice Address - Street 1:8121 NATIONAL AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7530
Practice Address - Country:US
Practice Address - Phone:405-732-7905
Practice Address - Fax:405-741-4622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0025261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical