Provider Demographics
NPI:1619547270
Name:GKW - ASRS, LLC
Entity Type:Organization
Organization Name:GKW - ASRS, LLC
Other - Org Name:THE SURGERY CENTER AT MERIDIAN PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MSN, RN
Authorized Official - Phone:913-940-0704
Mailing Address - Street 1:13313 N MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8380
Mailing Address - Country:US
Mailing Address - Phone:405-760-4671
Mailing Address - Fax:
Practice Address - Street 1:13313 N MERIDIAN AVE BLDG B1
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8380
Practice Address - Country:US
Practice Address - Phone:405-760-4671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-27
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty