Provider Demographics
NPI:1023003035
Name:SURGICAL SPECIALISTS OF OKLAHOMA, PLLC
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS OF OKLAHOMA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-842-4850
Mailing Address - Street 1:1000 W WILSHIRE BLVD
Mailing Address - Street 2:STE. 220
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7030
Mailing Address - Country:US
Mailing Address - Phone:405-842-4850
Mailing Address - Fax:405-848-2425
Practice Address - Street 1:1000 W WILSHIRE BLVD
Practice Address - Street 2:STE. 220
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7030
Practice Address - Country:US
Practice Address - Phone:405-842-4850
Practice Address - Fax:405-848-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty