Provider Demographics
NPI:1912567611
Name:MIDTOWN SURGICAL AND SKIN INSTITUTE PLLC
Entity Type:Organization
Organization Name:MIDTOWN SURGICAL AND SKIN INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LEEANN
Authorized Official - Last Name:HOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-600-0025
Mailing Address - Street 1:3336 E 32ND ST STE 250
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-4448
Mailing Address - Country:US
Mailing Address - Phone:918-600-0025
Mailing Address - Fax:918-600-0024
Practice Address - Street 1:3336 E 32ND ST STE 250
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-4448
Practice Address - Country:US
Practice Address - Phone:918-600-0025
Practice Address - Fax:918-600-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200845040AMedicaid
OK200346250AMedicaid