Provider Demographics
NPI:1245093699
Name:SOUTH TULSA PLASTIC SURGERY CENTER
Entity type:Organization
Organization Name:SOUTH TULSA PLASTIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIESEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-200-5454
Mailing Address - Street 1:224 S GATEWAY PL
Mailing Address - Street 2:STE 202
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037
Mailing Address - Country:US
Mailing Address - Phone:918-200-5454
Mailing Address - Fax:918-921-8155
Practice Address - Street 1:224 S GATEWAY PL
Practice Address - Street 2:STE 202
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037
Practice Address - Country:US
Practice Address - Phone:918-518-5144
Practice Address - Fax:918-921-8155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical