Organization
MERCY HEALTH CANADIAN COUNTY AMBULATORY SURGICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA L. SMALLEY (PRESIDENT & CEO)
(405) 752-3756
Entity
Organization
Contact information
Practice address
520 S MUSTANG RD, SUITE S, YUKON, OK 73099-6737
(405) 936-5900
(405) 577-2032
Mailing address
4401 W MEMORIAL RD, SUITE #141; ATTN: BECKY, OKLAHOMA CITY, OK 73134-1785
(405) 936-5811
(405) 936-5810
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0060
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000371045-001
BC/BS #
OK
Enumeration date
07/17/2006
Last updated
07/16/2007
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