Provider Demographics
NPI:1780313783
Name:SHO PROFESSIONAL SERVICES LLC
Entity type:Organization
Organization Name:SHO PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-846-0837
Mailing Address - Street 1:3705 NW 63RD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1937
Mailing Address - Country:US
Mailing Address - Phone:972-846-0837
Mailing Address - Fax:214-764-3113
Practice Address - Street 1:3130 SW 89TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7909
Practice Address - Country:US
Practice Address - Phone:972-846-0837
Practice Address - Fax:214-764-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty