Provider Demographics
NPI:1720080401
Name:SOONER ANESTHESIA SERVICES LLC
Entity Type:Organization
Organization Name:SOONER ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-742-2502
Mailing Address - Street 1:PO BOX 470191
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74147-0191
Mailing Address - Country:US
Mailing Address - Phone:918-742-2502
Mailing Address - Fax:918-745-9750
Practice Address - Street 1:4800 S 109TH E AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146
Practice Address - Country:US
Practice Address - Phone:918-742-2502
Practice Address - Fax:918-745-9750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK========= 001OtherBCBS OK
OK900522112Medicare ID - Type Unspecified