Provider Demographics
NPI:1366814121
Name:SMART SINUS OK, LLC
Entity type:Organization
Organization Name:SMART SINUS OK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-278-1885
Mailing Address - Street 1:13908 QUAILBROOK DR
Mailing Address - Street 2:QUAILBROOK MEDICAL CENTER BLDG C
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1718
Mailing Address - Country:US
Mailing Address - Phone:405-479-8625
Mailing Address - Fax:405-479-8627
Practice Address - Street 1:13908 QUAILBROOK DR
Practice Address - Street 2:QUAILBROOK BULDG C
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1718
Practice Address - Country:US
Practice Address - Phone:405-479-8625
Practice Address - Fax:405-479-8627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207YX0602X
IL03612239207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Multi-Specialty