Provider Demographics
NPI: | 1861035503 |
---|---|
Name: | ORA ORTHOPEDICS, PC |
Entity Type: | Organization |
Organization Name: | ORA ORTHOPEDICS, PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KENNETH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BROCKMAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 563-322-0971 |
Mailing Address - Street 1: | 2300 53RD AVE STE 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | BETTENDORF |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 52722-7565 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 563-322-0971 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2900 S 25TH ST STE B2 |
Practice Address - Street 2: | |
Practice Address - City: | CLINTON |
Practice Address - State: | IA |
Practice Address - Zip Code: | 52732-7250 |
Practice Address - Country: | US |
Practice Address - Phone: | 563-322-0971 |
Practice Address - Fax: | 563-324-0615 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | ORA ORTHOPEDICS, PC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2019-10-25 |
Last Update Date: | 2019-10-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
No | 207XP3100X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery | Group - Multi-Specialty |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | Group - Multi-Specialty |
No | 207XS0114X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | Group - Multi-Specialty |
No | 207XS0117X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | Group - Multi-Specialty |
No | 207XX0004X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | Group - Multi-Specialty |
No | 207XX0005X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | Group - Multi-Specialty |
No | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Multi-Specialty |
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | ||
No | 335E00000X | Suppliers | Prosthetic/Orthotic Supplier | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |