Provider Demographics
NPI:1659943157
Name:HEALTHCREST SURGICAL MANAGEMENT, LLC
Entity Type:Organization
Organization Name:HEALTHCREST SURGICAL MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, MANAGED CARE CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-697-2420
Mailing Address - Street 1:3540 S BOULEVARD STE 225
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5569
Mailing Address - Country:US
Mailing Address - Phone:405-697-2420
Mailing Address - Fax:405-697-2470
Practice Address - Street 1:3540 S BOULEVARD STE 225
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5569
Practice Address - Country:US
Practice Address - Phone:405-697-2420
Practice Address - Fax:405-697-2470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical