Provider Demographics
NPI:1942292073
Name:SOUTHERN OKLAHOMA SURGICAL CENTER INC
Entity Type:Organization
Organization Name:SOUTHERN OKLAHOMA SURGICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:580-226-5000
Mailing Address - Street 1:2412 NORTH COMMERCE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1356
Mailing Address - Country:US
Mailing Address - Phone:580-226-5000
Mailing Address - Fax:580-226-5035
Practice Address - Street 1:2412 NORTH COMMERCE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1356
Practice Address - Country:US
Practice Address - Phone:580-226-5000
Practice Address - Fax:580-226-5035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0023261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000371010001OtherBLUE CROSS BLUE SHIELD
OK100736890AMedicaid
OK490000424OtherRAILROAD MEDICARE
OK490000424OtherRAILROAD MEDICARE
OK=========-001OtherDEPT OF REHABILITATION
OK490000424OtherRAILROAD MEDICARE
OK=========Medicare PIN