# SOUTH TULSA ASC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174084982
- **Authorized official:** MR. TERRANCE WADE O'NEAL (OWNER/PARTNER)
- **Authorized official phone:** (623) 764-2780

## Contact information

- **Practice address:** 9840 E 81ST ST STE 200, TULSA, OK 74133-4584
- **Practice address phone:** (623) 764-2780
- **Mailing address:** 20235 N CAVE CREEK RD \# 104-472, PHOENIX, AZ 85024-4424
- **Mailing address phone:** (623) 764-2780

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/26/2019
- **Last updated:** 03/26/2019