Provider Demographics
NPI:1528231446
Name:NORTHWEST INSTITUTE OF SPORTS MEDICINE AND ORTHOPAEDIC SURGERY, PC
Entity Type:Organization
Organization Name:NORTHWEST INSTITUTE OF SPORTS MEDICINE AND ORTHOPAEDIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-787-7678
Mailing Address - Street 1:6221 REDBUD RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-3420
Mailing Address - Country:US
Mailing Address - Phone:405-787-7678
Mailing Address - Fax:405-751-3367
Practice Address - Street 1:4200 W MEMORIAL RD
Practice Address - Street 2:SUITE 1001
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9350
Practice Address - Country:US
Practice Address - Phone:405-787-7678
Practice Address - Fax:405-751-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13148282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD35082Medicare UPIN