Basic Information
| Provider Information | |||||||||
| NPI: | 1740531698 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OKLAHOMA SPORTS AND ORTHOPEDICS INSTITUTE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 W TECUMSEH RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730721810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053606764 | ||||||||
| FaxNumber: | 4053606769 | ||||||||
| Practice Location | |||||||||
| Address1: | 13401 N. WESTERN. AVE. | ||||||||
| Address2: | STE. 301 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4054787111 | ||||||||
| FaxNumber: | 4053606769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2012 | ||||||||
| LastUpdateDate: | 05/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | WEBSTER | ||||||||
| AuthorizedOfficialFirstName: | VALERIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 4053606764 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.