Provider Demographics
NPI:1396706578
Name:SURGICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:MEESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-505-3400
Mailing Address - Street 1:2448 E 81ST ST
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4250
Mailing Address - Country:US
Mailing Address - Phone:918-505-3400
Mailing Address - Fax:918-508-7070
Practice Address - Street 1:2448 E 81ST ST STE 1100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4205
Practice Address - Country:US
Practice Address - Phone:918-505-3400
Practice Address - Fax:918-508-7070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100729260AMedicaid
OK=========Medicare PIN
OK=========Medicare ID - Type Unspecified