Provider Demographics
NPI:1295864577
Name:CIMARRON SURGICAL AND UROLOGY
Entity Type:Organization
Organization Name:CIMARRON SURGICAL AND UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-372-2050
Mailing Address - Street 1:801 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4226
Mailing Address - Country:US
Mailing Address - Phone:405-372-2050
Mailing Address - Fax:405-743-3003
Practice Address - Street 1:801 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4226
Practice Address - Country:US
Practice Address - Phone:405-372-2050
Practice Address - Fax:405-743-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty