Organization
MCALESTER AMBULATORY SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID KEITH (CEO)
(918) 426-1800
Entity
Organization
Contact information
Practice address
4 E CLARK BASS BLVD, MCALESTER, OK 74501-4269
(918) 421-6700
(918) 421-6777
Mailing address
PO BOX 966, MCALESTER, OK 74502-0966
(918) 421-6700
(918) 421-6777
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0068
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000371048-001
BLUE CROSS/BLUE SHIELD
OK
05
—
100748940A
—
OK
01
—
175753300
DEPARTMENT OF LABOR - WC
OK
Enumeration date
10/28/2005
Last updated
04/29/2020
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