Provider Demographics
NPI:1689431553
Name:SOUTHWESTERN OKLAHOMA SURGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SOUTHWESTERN OKLAHOMA SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-699-3939
Mailing Address - Street 1:5374 NW CACHE RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3313
Mailing Address - Country:US
Mailing Address - Phone:580-699-3939
Mailing Address - Fax:
Practice Address - Street 1:5374 NW CACHE RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3313
Practice Address - Country:US
Practice Address - Phone:580-699-3939
Practice Address - Fax:580-699-3943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty