Provider Demographics
NPI:1790932002
Name:SURGICAL SPECIALISTS OF OKLAHOMA, PLLC
Entity Type:Organization
Organization Name:SURGICAL SPECIALISTS OF OKLAHOMA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:COSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-842-4850
Mailing Address - Street 1:PO BOX 7570
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-7570
Mailing Address - Country:US
Mailing Address - Phone:405-842-4850
Mailing Address - Fax:405-242-2180
Practice Address - Street 1:3705 NW 63RD
Practice Address - Street 2:STE. 212
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-0000
Practice Address - Country:US
Practice Address - Phone:405-608-4300
Practice Address - Fax:405-608-4302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURGICAL SPECIALISTS OF OKLAHOMA, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-19
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1891764197OtherNPI
OK1073655221OtherNPI
OK1083685630OtherNPI
OK1316901838OtherNPI
OK1881666220OtherNPI
OK1356305882OtherNPI
5390430003Medicare NSC