Provider Demographics
NPI:1326234584
Name:NORMAN SURGICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:NORMAN SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:SHI
Authorized Official - Last Name:CONNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-329-4102
Mailing Address - Street 1:500 E ROBINSON ST
Mailing Address - Street 2:2300
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6697
Mailing Address - Country:US
Mailing Address - Phone:405-329-4102
Mailing Address - Fax:405-364-3476
Practice Address - Street 1:500 E ROBINSON ST
Practice Address - Street 2:2300
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6697
Practice Address - Country:US
Practice Address - Phone:405-329-4102
Practice Address - Fax:405-364-3476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17833208600000X
OK23363208600000X
OK24274208600000X
OK26881208600000X
OK9306208G00000X
OKR0054197363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200127940AMedicaid
OK900522630Medicare PIN