Provider Demographics
NPI:1336460575
Name:ORTHOPEDIC AND SPINE CENTER OF OKLAHOMA, PC
Entity Type:Organization
Organization Name:ORTHOPEDIC AND SPINE CENTER OF OKLAHOMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PARCHURI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-805-7200
Mailing Address - Street 1:8165 S MINGO RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4668
Mailing Address - Country:US
Mailing Address - Phone:918-286-3124
Mailing Address - Fax:918-286-3764
Practice Address - Street 1:8165 S MINGO RD STE 201
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4668
Practice Address - Country:US
Practice Address - Phone:918-286-3124
Practice Address - Fax:918-286-3764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4109207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200029510AMedicaid
OK200029510AMedicaid
I04473Medicare UPIN