CERBERUS SURGICAL, PLLC (NPI# 1114340627) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114340627 |
| Entity Type | Organization |
| Organization Name | CERBERUS SURGICAL, PLLC |
| Practice Address |
1809 E 13th St Suite 200 Tulsa OK 74104-4419 |
| Mailing Address |
Po Box 108819 Oklahoma City OK 73101-8819 |
| Practice Telephone | 8174855100 |
| Practice Fax Number | 8174855101 |
| Mailing Telephone | 8174855100 |
| Mailing Fax Number | 8174855101 |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2016-11-18 |
| Authorized Official Name | CHARLES NEFF (DIRECTOR) |
| Authorized Official Telephone | 8174855100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | 200300503 | NC | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | K9947 | TX | Allopathic & Osteopathic Physicians |
| Y | 208600000X | Surgery | 23844 | OK | Allopathic & Osteopathic Physicians |
| Street Address |
1809 E 13TH ST SUITE 200 |
| City | TULSA |
| State | OK |
| Zip Code | 74104-4419 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861453102 | Brian A. Chalkin | Orthopaedic Surgery | 1809 E 13th St, Suite 100, Tulsa, OK 74104-4419 | 2006-03-28 |
| 1346779923 | Alyssa Puckett | Occupational Therapist | 1809 E 13th St, Tulsa, OK 74104-4419 | 2017-06-07 |
| 1275088635 | Samantha Kuplicki | Registered Nurse | 1809 E 13th St, Ste 400, Tulsa, OK 74104-4419 | 2016-08-15 |
| 1174975486 | Osu Center for Health Sciences | Clinic/Center | 1809 E 13th St, Suite 400, Tulsa, OK 74104-4419 | 2016-07-11 |
| 1063803146 | Tiffany Marie Ngo | Nurse Practitioner | 1809 E 13th St, Suite 400, Tulsa, OK 74104-4419 | 2015-02-11 |
| 1124468848 | Integrated Toxicology LLC | Clinical Medical Laboratory | 1809 E 13th St, Ste 300, Tulsa, OK 74104-4419 | 2013-06-26 |
| 1780935320 | Matthew Paul Giuliano | Physical Therapist | 1809 E 13th St, Suite 100, Tulsa, OK 74104-4419 | 2012-09-22 |
| 1528333515 | Amy Suzanne Garner | Nurse Practitioner | 1809 E 13th St, Tulsa, OK 74104-4419 | 2012-03-09 |
| 1689943870 | Shannon Nicole Delloiacono | Physician Assistant | 1809 E 13th St, Ste. 400, Tulsa, OK 74104-4419 | 2011-12-19 |
| 1649561713 | Chad Hanson | Orthopaedic Surgery | 1809 E 13th St, Tulsa, OK 74104-4419 | 2011-04-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982253811 | Ultimate Health and Pain Management | Pain Medicine | 1844 East 15th Street, Tulsa, OK 74104 | 2019-09-04 |
| 1225691223 | David Murray | Student in an Organized Health Care Education/Training Program | 2100 S Wheeling Ave, Tulsa, OK 74104 | 2019-04-16 |
| 1083115828 | Susan Fortner | Counselor | 1328 S. Delaware Pl, Tulsa, OK 74104 | 2018-02-27 |
| 1033636915 | Mark Brizendine | Dietitian, Registered | Hillcrest Medical Center 1120 S. Utica Ave, Tulsa, OK 74104 | 2017-08-23 |
| 1295259067 | Demi Reyd Cook | Nurse Practitioner | 1717 A South Utica, Tulsa, OK 74104 | 2017-08-02 |
| 1851827059 | Oklahoma Cvs Pharmacy | Durable Medical Equipment & Medical Supplies | 1701 E 15th Street, Tulsa, OK 74104 | 2017-05-08 |
| 1801334982 | Jamie Lynne Miller | Internal Medicine | 2000 S. Wheeling Avenue Ste 510, Tulsa, OK 74104 | 2017-02-08 |
| 1578913430 | Donna Durant-macon | Registered Nurse | 315 South Utica, Tulsa, OK 74104 | 2016-06-21 |
| 1669833851 | Mbc Dental | Dentist | 401 S. Utica Ave, #a, Tulsa, OK 74104 | 2016-03-15 |
| 1518332170 | Neuro Dynamics LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 22 S Lewis, Tulsa, OK 74104 | 2015-12-08 |
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| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730702127 | Advanced Surgical Assisting, LLC | Surgery | 4012 E 108th St, Tulsa, OK 74137-6707 | 2020-05-20 |
| 1376016329 | Oklahoma Acute Care Surgical Specialists LLC | Surgery | 4016 E 27th St, Tulsa, OK 74114-5908 | 2019-01-02 |
| 1831540608 | Eric Waetjen | Surgery | 4502 E 51st St, 2g06, Tulsa, OK 74135-3702 | 2016-06-23 |
| 1538418504 | Daniel Kent Towsley | Surgery | 2502 E 45th St, Tulsa, OK 74105-5147 | 2012-09-05 |
| 1235420043 | Ty Douglas Kirkpatrick | Surgery | 1725 E 19th St Ste 800, Tulsa, OK 74104-5464 | 2011-04-27 |
| 1689965741 | John Skelly Watson | Surgery | 803 S Jackson Ave, Suite 130, Tulsa, OK 74127-9010 | 2011-04-25 |
| 1528386984 | William Aaron Hanner | Surgery | 5555 E 71st St Ste 7250, Tulsa, OK 74136-6554 | 2010-05-11 |
| 1316181720 | Patrick James Ross | Surgery | 6475 S Yale Ave Ste 406, Tulsa, OK 74136-7818 | 2009-04-29 |
| 1831375500 | Nicole Marie Castellese | Surgery | 1723 E 15th St Ste 100, Tulsa, OK 74104-4608 | 2008-01-12 |
| 1508063975 | Dr Richard Lee Cooper PC | Surgery | 10131 S Yale Ave Ste 200, Tulsa, OK 74137-6012 | 2007-06-29 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.