Provider Demographics
NPI:1871542639
Name:SURGICAL SPECIALISTS OF OKLAHOMA PLLC
Entity type:Organization
Organization Name:SURGICAL SPECIALISTS OF OKLAHOMA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-737-8455
Mailing Address - Street 1:230 N MIDWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4321
Mailing Address - Country:US
Mailing Address - Phone:405-737-8455
Mailing Address - Fax:
Practice Address - Street 1:230 N MIDWEST BLVD
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4321
Practice Address - Country:US
Practice Address - Phone:405-737-8455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA121446OtherMEDICARE GROUP HIGHMARK
OK100747340AMedicaid
OK100747340AMedicaid
OK5390430014Medicare NSC
OK5390430002Medicare NSC
OK5390430008Medicare NSC
OK5390430011Medicare NSC
OK5390430012Medicare NSC
PA121446OtherMEDICARE GROUP HIGHMARK
OK5390430004Medicare NSC
OK5390430007Medicare NSC
OK5390430005Medicare NSC
OK5390430009Medicare NSC
OK5390430016Medicare NSC
OK800522427Medicare ID - Type Unspecified
OK5390430001Medicare NSC
OK5390430006Medicare NSC
OK5390430018Medicare NSC
OK5390430017Medicare NSC
OK5390430019Medicare NSC
OK5390430003Medicare NSC