Provider Demographics
NPI:1962716597
Name:ALTUS SURGICAL&UROLOGY ASSOCIATES, PLLC
Entity type:Organization
Organization Name:ALTUS SURGICAL&UROLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOUNIR
Authorized Official - Middle Name:G
Authorized Official - Last Name:ZAKHARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-379-6550
Mailing Address - Street 1:PO BOX 975
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73522-0975
Mailing Address - Country:US
Mailing Address - Phone:580-379-6550
Mailing Address - Fax:580-379-6559
Practice Address - Street 1:304 S PARK LN
Practice Address - Street 2:SUITE B
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-5753
Practice Address - Country:US
Practice Address - Phone:580-379-6550
Practice Address - Fax:580-379-6559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD35441Medicare UPIN