Provider Demographics
NPI:1659313138
Name:FOUNDATION BARIATRIC HOSPITAL OF OKLAHOMA, LLC
Entity Type:Organization
Organization Name:FOUNDATION BARIATRIC HOSPITAL OF OKLAHOMA, LLC
Other - Org Name:FOUNDATION BARIATRIC HOSPITAL OF OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:405-359-2465
Mailing Address - Street 1:PO BOX 20485
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-0485
Mailing Address - Country:US
Mailing Address - Phone:405-359-2488
Mailing Address - Fax:
Practice Address - Street 1:1800 RENAISSANCE BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3023
Practice Address - Country:US
Practice Address - Phone:405-359-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2370282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000370225001OtherBC/BS PROVIDER NUMBER
OK370225Medicare Oscar/Certification