Organization
ENID SURGICAL ANESTHESIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY RENEE' WISE (BUSINESS ADMINISTRATOR)
(580) 233-7171
Entity
Organization
Contact information
Practice address
1133 W WILLOW RD, ENID, OK 73703-2504
(580) 233-7171
(580) 233-6680
Mailing address
1133 W WILLOW RD, ENID, OK 73703-2504
(580) 233-7171
(580) 233-6680
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2665
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OKB6060
PTAN
OK
Enumeration date
07/08/2011
Last updated
01/10/2012
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