Provider Demographics
NPI:1609826148
Name:CENTRAL STATES ORTHOPEDIC SPECIALISTS, INC.
Entity Type:Organization
Organization Name:CENTRAL STATES ORTHOPEDIC SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:918-481-7616
Mailing Address - Street 1:6585 S YALE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8384
Mailing Address - Country:US
Mailing Address - Phone:918-481-2767
Mailing Address - Fax:918-481-7611
Practice Address - Street 1:6585 S YALE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8384
Practice Address - Country:US
Practice Address - Phone:918-481-2767
Practice Address - Fax:918-481-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100744260AMedicaid
=========OtherFEIN
=========Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER