Organization
ZACKER ANESTHESIA SERVICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN P ZACKER MD (OWNER)
(405) 602-8100
Entity
Organization
Contact information
Practice address
3100 SW 89TH ST, OKLAHOMA CITY, OK 73159-7900
(405) 602-8100
Mailing address
PO BOX 1547, SEDALIA, MO 65302-1547
(660) 826-5960
(660) 826-4852
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200093950A
—
OK
01
—
611997100
DEPT OF LABOR
OK
01
—
DG2083
RR MEDICARE
OK
Enumeration date
09/25/2006
Last updated
07/21/2022
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