Provider Demographics
NPI:1164601241
Name:SURGICAL SPECIALISTS OF OKLAHOMA PLLC
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS OF OKLAHOMA PLLC
Other - Org Name:SHARTEL CLINIC
Other - Org Type:Other Name
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:PO BOX 268848
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8848
Mailing Address - Country:US
Mailing Address - Phone:405-842-4850
Mailing Address - Fax:405-842-9612
Practice Address - Street 1:1211 N SHARTEL AVE
Practice Address - Street 2:STE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2400
Practice Address - Country:US
Practice Address - Phone:405-242-2101
Practice Address - Fax:405-842-9612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURGICAL SPECIALISTS OF OKLAHOMA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-25
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1679535470OtherNPI
OK1790747293OtherNPI
OK1326000191OtherNPI
OK1326000191OtherNPI