Provider Demographics
NPI:1578749065
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:918-477-5071
Mailing Address - Fax:918-477-5978
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:918-477-5071
Practice Address - Fax:918-477-5978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OKLAHOMA SURGICAL HOSPITAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-14
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100748450BMedicaid
CAZZZ23277ZMedicare PIN