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Organization

OUTPATIENT SURGICAL CENTER OF PONCA CITY, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. STEFFI MOON COWAN (ADMINISTRATOR)
(580) 762-0695
Entity
Organization

Contact information

Practice address
400 FAIRVIEW AVE, SUITE 50, PONCA CITY, OK 74601-1920
(580) 762-0695
(580) 765-9406
Mailing address
400 FAIRVIEW AVE, SUITE 50, PONCA CITY, OK 74601-1920
(580) 762-0695
(580) 765-9406

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0021
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200037990A
OK
Enumeration date
04/25/2006
Last updated
11/01/2010
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