Providence Surgical Group at Bailey PLLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

24688 Issued in OK

Legal business name

PROVIDENCE SURGICAL GROUP AT BAILEY PLLC

Practice address

10512 N 110TH East Ave
Suite 200
Owasso, OK 74055

Phone

(918) 344-6266

Fax

(918) 298-2138

NPI assigned

Jan 10, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michael D Mann, M.D.

Title

Owner

Phone

(918) 298-2138

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376692095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 E 122ND PL",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740372860",
            "telephone_number": "918-298-2138",
            "fax_number": "918-298-2138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10512 N 110TH EAST AVE",
            "address_2": "SUITE 200",
            "city": "OWASSO",
            "state": "OK",
            "postal_code": "74055",
            "telephone_number": "918-344-6266",
            "fax_number": "918-298-2138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE SURGICAL GROUP AT BAILEY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MANN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-298-2138",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "OK",
            "license": "24688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Poulin, PTA
• Timothy Blake Poulter, PHARM D.
• Jillian Renae Prather, D.M.D.
• Desirea Christine Prelesnick
• Beverly Lynn Prentice, M.S., R.D., L.D.
• Psi Premier Specialties, Inc.
• Purpose Pediatrics LLC
• Pursuit Wellness
• Alexander Joseph Quante, DDS
• Adam Quarterson, PHARMD

• Surgery Physician in Owasso, OK
• Providers in Owasso, OK by specialty
• Surgery Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.