Provider Demographics
NPI:1477551745
Name:GP SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:GP SURGERY CENTER, LLC
Other - Org Name:GREAT PLAINS AMBULATORY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3859
Mailing Address - Street 1:5404 SOUTHWEST LEE BOULEVARD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9521
Mailing Address - Country:US
Mailing Address - Phone:580-536-7533
Mailing Address - Fax:580-536-7535
Practice Address - Street 1:5404 SOUTHWEST LEE BOULEVARD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9521
Practice Address - Country:US
Practice Address - Phone:580-536-7533
Practice Address - Fax:580-536-7535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0027261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200008100AMedicaid
OK490005778OtherRAILROAD MEDICARE
OK000371019001OtherBLUE CROSS PROVIDER NUMBE
000371019001OtherBLUE CROSS
OK000371019001OtherBLUE CROSS PROVIDER NUMBE
OK200008100AMedicaid