NPIMap

Organization Active NPI

Enid Surgical Anesthesia LLC

  • Anesthesiology Physician
  • Enid, OK
National Provider Identifier
1134416373
Registry record updated Jan 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
2665 Issued in OK
Legal business name
ENID SURGICAL ANESTHESIA LLC
Practice address
1133 W Willow Rd
Enid, OK 73703-2504
Phone
(580) 233-7171
Fax
(580) 233-6680
NPI assigned
Jul 8, 2011
Last updated
Jan 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Kimberly Renee' Wise
Title
Business Administrator
Phone
(580) 233-7171

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 2665 OK Primary

Addresses

Primary practice location

1133 W Willow Rd
Enid, OK 73703-2504

Mailing address

1133 W Willow Rd
Enid, OK 73703-2504
Phone (580) 233-7171

Other identifiers 1

IdentifierTypeStateIssuer
OKB6060OtherOKPTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120104000608 OK Part B Supplier - Clinic/Group Practice 6002082567 Receives reassigned benefits from 3 practitioners
Practice locations: Enid, OK

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1310083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326153600000",
    "number": "1134416373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 W WILLOW RD",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737032504",
            "telephone_number": "580-233-7171",
            "fax_number": "580-233-6680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 W WILLOW RD",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737032504",
            "telephone_number": "580-233-7171",
            "fax_number": "580-233-6680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENID SURGICAL ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-08",
        "last_updated": "2012-01-10",
        "status": "A",
        "authorized_official_last_name": "WISE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "RENEE'",
        "authorized_official_title_or_position": "BUSINESS ADMINISTRATOR",
        "authorized_official_telephone_number": "580-233-7171",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OK",
            "license": "2665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "OKB6060",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Enid, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.