Provider Demographics
NPI:1760646459
Name:SURGICAL SPECIALISTS INC.
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ORVILLLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RICKEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:M,D
Authorized Official - Phone:405-942-9949
Mailing Address - Street 1:3511 NW 41ST STREET
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-942-9949
Mailing Address - Fax:405-942-9959
Practice Address - Street 1:3511 NW 41ST STREET
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-942-9949
Practice Address - Fax:405-942-9959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
73093504003OtherBCBS
OKD35196Medicare UPIN