Provider Demographics
NPI:1033229240
Name:SURGICAL HOSPITAL OF OKLAHOMA LLC
Entity Type:Organization
Organization Name:SURGICAL HOSPITAL OF OKLAHOMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-754-3169
Mailing Address - Street 1:100 SOUTHEAST 59TH
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73129-3616
Mailing Address - Country:US
Mailing Address - Phone:405-635-3027
Mailing Address - Fax:405-616-7049
Practice Address - Street 1:100 SOUTHEAST 59TH
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-3616
Practice Address - Country:US
Practice Address - Phone:405-635-3027
Practice Address - Fax:405-616-7049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2338282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH=========9Medicaid
OK370201Medicare ID - Type Unspecified