Provider Demographics
NPI:1477223451
Name:ORTHO PLUS LLC
Entity Type:Organization
Organization Name:ORTHO PLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:HOLLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:405-227-1280
Mailing Address - Street 1:301 LILAC DR STE 140
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-7288
Mailing Address - Country:US
Mailing Address - Phone:405-906-3375
Mailing Address - Fax:
Practice Address - Street 1:2002 12TH AVE NW STE E
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1206
Practice Address - Country:US
Practice Address - Phone:580-226-7587
Practice Address - Fax:580-226-4878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200630750BMedicaid