Provider Demographics
NPI:1750597449
Name:OKLAHOMA LITHOTRIPTER ASSOCIATES, L.C.
Entity type:Organization
Organization Name:OKLAHOMA LITHOTRIPTER ASSOCIATES, L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIR
Authorized Official - Prefix:
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-604-4183
Mailing Address - Street 1:5401 N PORTLAND AVE STE 640
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2130
Mailing Address - Country:US
Mailing Address - Phone:405-604-4160
Mailing Address - Fax:405-604-4053
Practice Address - Street 1:5401 N PORTLAND AVE STE 650
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2081
Practice Address - Country:US
Practice Address - Phone:405-604-4160
Practice Address - Fax:405-604-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
OK0086261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical