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37D0471506 CLIA NUMBER - OKLAHOMA SURGICARE

Laboratory Demographics

CLIA Number: 37D0471506

Facility Name: OKLAHOMA SURGICARE

Facility Address:
4317 W MEMORIAL RD ATTN BRENT KOONCE
OKLAHOMA CITY, OK
ZIP 73134
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Facility Phone Number: 405 755-6240

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver
NPI Number: 1487978540

Taxonomy: 207RH0003X - Internal Medicine
An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.

CLIA Record

Field Name Field Value
CLIA Number 37D0471506
LAB Type Ambulatory Surgery Center
Facility Name OKLAHOMA SURGICARE
Street 4317 W MEMORIAL RD ATTN BRENT KOONCE
City OKLAHOMA CITY
State OK
ZIP 73134
Phone 405 755-6240
CertificateType 4
CertificateEffectiveDate 9/1/2022
CertificateExpirationDate 8/31/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024