Provider Demographics
NPI:1538246384
Name:PREMIER ANESTHESIA OF OKLAHOMA CITY
Entity type:Organization
Organization Name:PREMIER ANESTHESIA OF OKLAHOMA CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NORBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUMMEL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:877-742-0399
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30515-0490
Mailing Address - Country:US
Mailing Address - Phone:770-614-6777
Mailing Address - Fax:770-614-6070
Practice Address - Street 1:4401 S WESTERN AVE
Practice Address - Street 2:INTEGRIS SOUTHWEST MEDICAL CENTER - ANESTHESIA DEPT
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3413
Practice Address - Country:US
Practice Address - Phone:405-636-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty