Provider Demographics
NPI:1376656546
Name:SOUTHERN OKLAHOMA MULTIPLE SERVICES INC P C
Entity Type:Organization
Organization Name:SOUTHERN OKLAHOMA MULTIPLE SERVICES INC P C
Other - Org Name:BONE & JOINT CLINIC OF SOUTHERN OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:TROOP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-223-4795
Mailing Address - Street 1:2002 12TH AVE NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1206
Mailing Address - Country:US
Mailing Address - Phone:580-223-4795
Mailing Address - Fax:580-223-5184
Practice Address - Street 1:2002 12TH AVE NW
Practice Address - Street 2:SUITE B
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1206
Practice Address - Country:US
Practice Address - Phone:580-223-4795
Practice Address - Fax:580-223-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC11578OtherRAILROAD MEDICARE
OK100747150AMedicaid
OK=========001OtherBLUE CROSS BLUE SHIELD
OK800522016Medicare ID - Type Unspecified
OK1224880001Medicare NSC