Provider Demographics
NPI:1235316829
Name:ORTHOPEDIC & TRAUMA SERVICE OF OKLAHOMA, PC
Entity Type:Organization
Organization Name:ORTHOPEDIC & TRAUMA SERVICE OF OKLAHOMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETSY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-392-4547
Mailing Address - Street 1:5110 S YALE AVE STE 525
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-7485
Mailing Address - Country:US
Mailing Address - Phone:918-392-4547
Mailing Address - Fax:918-392-4555
Practice Address - Street 1:5110 S YALE AVE STE 525
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7485
Practice Address - Country:US
Practice Address - Phone:918-392-4547
Practice Address - Fax:918-392-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207XX0801X
OK261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200221390AMedicaid
OK6362230001Medicare NSC
OKOKB5012Medicare UPIN