Provider Demographics
NPI:1629371687
Name:GREATER NORMAN SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:GREATER NORMAN SURGERY CENTER, LLC
Other - Org Name:CENTRAL OKLAHOMA SURGICAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRERUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-395-1086
Mailing Address - Street 1:PO BOX 258816
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73125-8816
Mailing Address - Country:US
Mailing Address - Phone:855-395-1086
Mailing Address - Fax:
Practice Address - Street 1:3400 W TECUMSEH RD
Practice Address - Street 2:SUITE 301
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-1810
Practice Address - Country:US
Practice Address - Phone:855-395-1086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0094261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical