Provider Demographics
NPI:1265689814
Name:ORTHOCARE SERVICES
Entity Type:Organization
Organization Name:ORTHOCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-310-3344
Mailing Address - Street 1:1322 N INTERSTATE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3393
Mailing Address - Country:US
Mailing Address - Phone:405-310-3344
Mailing Address - Fax:405-310-3340
Practice Address - Street 1:1322 N INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-3393
Practice Address - Country:US
Practice Address - Phone:405-310-3344
Practice Address - Fax:405-310-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5313490001Medicare NSC