Provider Demographics
NPI:1619982063
Name:TULSA ORTHOPEDIC SURGEONS
Entity Type:Organization
Organization Name:TULSA ORTHOPEDIC SURGEONS
Other - Org Name:THE SPINE AND ORTHOPEDIC INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-994-4000
Mailing Address - Street 1:9709 E 79TH ST SOUTH
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133
Mailing Address - Country:US
Mailing Address - Phone:918-994-4000
Mailing Address - Fax:918-994-4090
Practice Address - Street 1:9709 E 79TH ST SOUTH
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133
Practice Address - Country:US
Practice Address - Phone:918-994-4000
Practice Address - Fax:918-994-4090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK400522057Medicare PIN