Provider Demographics
NPI:1326095068
Name:ORTHOPEDIC AND RECONSTRUCTIVE CENTER P C
Entity Type:Organization
Organization Name:ORTHOPEDIC AND RECONSTRUCTIVE CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:OREB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-609-6146
Mailing Address - Street 1:1044 SW 44TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3609
Mailing Address - Country:US
Mailing Address - Phone:405-631-4263
Mailing Address - Fax:405-631-4891
Practice Address - Street 1:1044 SW 44TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3609
Practice Address - Country:US
Practice Address - Phone:405-631-4263
Practice Address - Fax:405-631-4891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKN/A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========Medicare PIN
OKCE7886Medicare PIN
OK0804230001Medicare NSC