Provider Demographics
NPI:1720535933
Name:SOUTHWEST OKLAHOMA SURGERY PLLC
Entity Type:Organization
Organization Name:SOUTHWEST OKLAHOMA SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SPURGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-786-4008
Mailing Address - Street 1:3085 BROOKWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1355
Mailing Address - Country:US
Mailing Address - Phone:580-786-4008
Mailing Address - Fax:580-786-4012
Practice Address - Street 1:3085 BROOKWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1355
Practice Address - Country:US
Practice Address - Phone:580-786-4008
Practice Address - Fax:580-786-4012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32407208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty