Provider Demographics
NPI:1881102614
Name:WESTERN OKLAHOMA ANESTHESIA CONSULTANTS PLLC
Entity type:Organization
Organization Name:WESTERN OKLAHOMA ANESTHESIA CONSULTANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-339-8001
Mailing Address - Street 1:1710 W 3RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-5160
Mailing Address - Country:US
Mailing Address - Phone:580-339-8001
Mailing Address - Fax:580-339-8031
Practice Address - Street 1:1801 W 3RD ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-5145
Practice Address - Country:US
Practice Address - Phone:580-339-8001
Practice Address - Fax:580-339-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-15
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31425207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty