Provider Demographics
NPI:1477674711
Name:NEUROSURGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:NEUROSURGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-813-2600
Mailing Address - Street 1:DEPT. 96-0321
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0321
Mailing Address - Country:US
Mailing Address - Phone:405-813-2600
Mailing Address - Fax:405-813-2633
Practice Address - Street 1:4600 SE 29TH ST
Practice Address - Street 2:760
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-3406
Practice Address - Country:US
Practice Address - Phone:405-813-2600
Practice Address - Fax:405-813-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24324174400000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200057730AMedicaid
OK6191230001Medicare NSC