Provider Demographics
NPI:1114173861
Name:NEUROSURGICAL AND SPINE ASSOCIATES OF OKLAHOMA, PC
Entity Type:Organization
Organization Name:NEUROSURGICAL AND SPINE ASSOCIATES OF OKLAHOMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:QUALLS
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-455-3322
Mailing Address - Street 1:8 SW 89TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-8534
Mailing Address - Country:US
Mailing Address - Phone:405-455-3322
Mailing Address - Fax:405-606-4330
Practice Address - Street 1:8 SW 89TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-8534
Practice Address - Country:US
Practice Address - Phone:405-455-3322
Practice Address - Fax:405-606-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4688207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty