Organization
CHERRY STREET SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK L MATHERS D.O. (MEDICAL DIRECTOR)
(918) 749-7177
Entity
Organization
Contact information
Practice address
1844 E 15TH ST, TULSA, OK 74104-4611
(918) 749-7177
Mailing address
1844 E 15TH ST, TULSA, OK 74104-4611
(918) 749-7177
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0046
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100748420A
—
OK
01
—
731572836-001
BLUE CROSS BLUE SHIELD
OK
Enumeration date
12/21/2006
Last updated
10/07/2008
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