| Cherry Street Surgery Center, Llc | |
|
1844 E 15th St Tulsa OK 74104-4611 | |
| (918) 749-7177 | |
| Not Available |
| Full Name | Cherry Street Surgery Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1844 E 15th St, Tulsa, Oklahoma |
| Authorized Official Name and Position | Mark L Mathers (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9187497177 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cherry Street Surgery Center, Llc 1844 E 15th St Tulsa OK 74104-4611 Ph: (918) 749-7177 | Cherry Street Surgery Center, Llc 1844 E 15th St Tulsa OK 74104-4611 Ph: (918) 749-7177 |
| NPI Number | 1902960198 |
|---|---|
| Provider Enumeration Date | 12/21/2006 |
| Last Update Date | 10/07/2008 |
| Medicare PECOS PAC ID | 4385770973 |
|---|---|
| Medicare Enrollment ID | O20100408000110 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902960198 | NPI | - | NPPES |
| 100748420A | Medicaid | OK | |
| 731572836-001 | Other | OK | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 0046 (Oklahoma) | Primary |
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