# CIMARRON AMBULATORY SERVICES, LLC

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

## Provider details

- **NPI number:** 1255524989
- **Authorized official:** MARK GALLIART (VP BUSINESS DEVELOPMENT)
- **Authorized official phone:** (405) 372-1480

## Contact information

- **Practice address:** 1323 W 6TH AVE, STILLWATER, OK 74074-4306
- **Practice address phone:** (405) 742-5300
- **Practice address fax:** (405) 742-4990
- **Mailing address:** 1323 W 6TH AVE, STILLWATER, OK 74074-4306
- **Mailing address phone:** (405) 742-5300
- **Mailing address fax:** (405) 742-4990

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 2084N0400X | Neurology Physician | — | NULL | — |
| 2084N0400X | Neurology Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208M00000X | Hospitalist Physician | — | NULL | — |
| 208M00000X | Hospitalist Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | — |
| 208VP0000X | Pain Medicine Physician | — | — | — |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | NULL | — |
| 367500000X | Certified Registered Nurse Anesthetist | — | — | — |

## Other

- **Enumeration date:** 08/27/2007
- **Last updated:** 08/27/2007