Provider Demographics
NPI:1184685901
Name:GCSC
Entity Type:Organization
Organization Name:GCSC
Other - Org Name:GONCE COSMETIC SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GONCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-748-3636
Mailing Address - Street 1:3333 NW 63RD ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3710
Mailing Address - Country:US
Mailing Address - Phone:405-748-3636
Mailing Address - Fax:405-749-9421
Practice Address - Street 1:3333 NW 63RD ST
Practice Address - Street 2:SUITE 250
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3710
Practice Address - Country:US
Practice Address - Phone:405-748-3636
Practice Address - Fax:405-749-9421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical