Provider Demographics
NPI:1467466383
Name:CENTRAL OKLAHOMA AMBULATORY SURGICAL CENTER, INC.
Entity Type:Organization
Organization Name:CENTRAL OKLAHOMA AMBULATORY SURGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:KORBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-947-3330
Mailing Address - Street 1:3301 NW 63RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3705
Mailing Address - Country:US
Mailing Address - Phone:405-947-3330
Mailing Address - Fax:405-947-3494
Practice Address - Street 1:3301 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3705
Practice Address - Country:US
Practice Address - Phone:405-947-3330
Practice Address - Fax:405-947-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0016207W00000X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty