Organization Active NPI

Neurosurgery Center of Southwest Oklahoma Inc

  • Neurological Surgery Physician
  • Lawton, OK
National Provider Identifier
1558675785
Registry record updated Jun 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
21457 Issued in OK
Legal business name
NEUROSURGERY CENTER OF SOUTHWEST OKLAHOMA INC
Practice address
3201 W Gore Blvd
Lawton, OK 73505-6378
Phone
(580) 353-6000
Fax
(580) 353-0800
NPI assigned
Jul 29, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2012

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

Authorized official

Name
Dr. Stephen K. Ofori-Kwakye, M.D.NPI 1013975580
Title
President
Phone
(580) 353-6000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207T00000X 21457 OK Primary

Addresses

Primary practice location

3201 W Gore Blvd
Lawton, OK 73505-6378

Mailing address

3201 W Gore Blvd
Lawton, OK 73505-6378
Phone (580) 353-6000

Other identifiers 2

IdentifierTypeStateIssuer
OKA103466OtherOKPTAN
100000050AMedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110720000472 OK Part B Supplier - Clinic/Group Practice 7315115219 Receives reassigned benefits from 1 practitioner
Practice locations: Lawton, OK

National Provider Directory

National Provider Directory

Locations

3201 W Gore Blvd
Lawton, OK 73505
Phone (580) 250-5385

3201 W Gore Blvd
Ste 303
Lawton, OK 73505
Phone (580) 353-6000

Practitioners & affiliated clinicians

Practitioners 1

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": "1280361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339027200000",
    "number": "1558675785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056378",
            "telephone_number": "580-353-6000",
            "fax_number": "580-353-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056378",
            "telephone_number": "580-353-6000",
            "fax_number": "580-353-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROSURGERY CENTER OF SOUTHWEST OKLAHOMA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-29",
        "last_updated": "2012-06-07",
        "status": "A",
        "authorized_official_last_name": "OFORI-KWAKYE",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "580-353-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": "OK",
            "license": "21457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "OKA103466",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100000050A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.