# ARDMORE REGIONAL SURGERY CENTER, LLC

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

## Provider details

- **NPI number:** 1376709907
- **Authorized official:** MS. SALLY A GODFREY CASC (ADMINISTRATOR)
- **Authorized official phone:** (580) 224-0007

## Contact information

- **Practice address:** 2002 12TH AVE NW, SUITE C, ARDMORE, OK 73401-1227
- **Practice address phone:** (580) 224-0007
- **Practice address fax:** (580) 223-7140
- **Mailing address:** 2002 12TH AVE NW, SUITE C, ARDMORE, OK 73401-1227
- **Mailing address phone:** (580) 224-0007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 0064 | OK | Yes |

## Other

- **Enumeration date:** 08/04/2008
- **Last updated:** 08/04/2008