Provider Demographics
NPI:1093792681
Name:COSMETIC SURGERY CENTER OF ARDMORE LLC
Entity Type:Organization
Organization Name:COSMETIC SURGERY CENTER OF ARDMORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALOOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-226-2171
Mailing Address - Street 1:818 16TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1818
Mailing Address - Country:US
Mailing Address - Phone:580-226-2171
Mailing Address - Fax:580-226-2772
Practice Address - Street 1:818 16TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1818
Practice Address - Country:US
Practice Address - Phone:580-226-2171
Practice Address - Fax:580-226-2772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical