Provider Demographics
NPI:1316010150
Name:ORTHOPEDIC CENTER OF MUSKOGEE
Entity Type:Organization
Organization Name:ORTHOPEDIC CENTER OF MUSKOGEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:FOREST
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-686-6600
Mailing Address - Street 1:3900 WEST BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401
Mailing Address - Country:US
Mailing Address - Phone:918-686-6600
Mailing Address - Fax:918-686-6601
Practice Address - Street 1:3900 WEST BROADWAY
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401
Practice Address - Country:US
Practice Address - Phone:918-686-6600
Practice Address - Fax:918-686-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00007143OtherRAILROAD MEDICARE
OKP00007143OtherRAILROAD MEDICARE