Provider Demographics
NPI:1396984456
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:
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 1:2349 N THOMPKINS AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-5307
Practice Address - Country:US
Practice Address - Phone:405-495-6134
Practice Address - Fax:405-787-8466
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURGICAL SPECIALISTS OF OKLAHOMA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-13
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
OK1205879772OtherNPI
OK5390430012Medicare NSC