Provider Demographics
NPI:1740277318
Name:CONSULTING ANESTHESIOLOGY OF NORMAN INC
Entity type:Organization
Organization Name:CONSULTING ANESTHESIOLOGY OF NORMAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMPBELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLESPIE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:405-947-8585
Mailing Address - Street 1:PO BOX 271086
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-1086
Mailing Address - Country:US
Mailing Address - Phone:405-947-8585
Mailing Address - Fax:405-948-6507
Practice Address - Street 1:4400 WILL ROGERS PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1837
Practice Address - Country:US
Practice Address - Phone:405-947-8585
Practice Address - Fax:405-948-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18211207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
453807914001OtherBCBS
OKOKB5145Medicare PIN
E04492Medicare UPIN
CS5068Medicare PIN