Provider Demographics
NPI:1487651857
Name:OKLAHOMA SURGICAL HOSPITAL, LLC
Entity Type:Organization
Organization Name:OKLAHOMA SURGICAL HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-477-5049
Mailing Address - Street 1:2408 E 81ST ST
Mailing Address - Street 2:STE 900
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4217
Mailing Address - Country:US
Mailing Address - Phone:918-477-5100
Mailing Address - Fax:918-477-5930
Practice Address - Street 1:2408 E 81ST ST
Practice Address - Street 2:STE 900
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4217
Practice Address - Country:US
Practice Address - Phone:918-477-5100
Practice Address - Fax:918-477-5930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2350282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100748450BMedicaid
OK370210Medicare Oscar/Certification
OK700522145Medicare PIN
CAZZZ23277ZMedicare PIN