Provider Demographics
NPI:1235298241
Name:ANESTHESIA OF ENID LLC
Entity Type:Organization
Organization Name:ANESTHESIA OF ENID LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-242-3003
Mailing Address - Street 1:1220 W WILLOW RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-2511
Mailing Address - Country:US
Mailing Address - Phone:580-242-3003
Mailing Address - Fax:
Practice Address - Street 1:600 S MONROE ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7211
Practice Address - Country:US
Practice Address - Phone:580-233-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANESTHESIOLOGY MANAGEMENT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-06
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1235298241Medicaid