Provider Demographics
NPI:1902043086
Name:UROLOGY SURGEONS OF OKLAHOMA PC
Entity Type:Organization
Organization Name:UROLOGY SURGEONS OF OKLAHOMA PC
Other - Org Name:UROLOGY SURGEONS OF OKLAHOMA PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HASSOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-749-9889
Mailing Address - Street 1:4200 W MEMORIAL RD STE 501
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8359
Mailing Address - Country:US
Mailing Address - Phone:405-749-9889
Mailing Address - Fax:405-755-1166
Practice Address - Street 1:4200 W MEMORIAL RD STE 501
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8359
Practice Address - Country:US
Practice Address - Phone:405-749-9889
Practice Address - Fax:405-755-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKDO9183OtherRAILROAD MEDICARE
OK200240460AMedicaid
OKF46786Medicare UPIN
OKDO9183OtherRAILROAD MEDICARE