Provider Demographics
NPI:1255381471
Name:ORTHOCARE SERVICES LLC
Entity type:Organization
Organization Name:ORTHOCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRKS
Authorized Official - Suffix:
Authorized Official - Credentials:CO L
Authorized Official - Phone:405-703-1472
Mailing Address - Street 1:2305 S. I-35 SERVICE ROAD
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2775
Mailing Address - Country:US
Mailing Address - Phone:405-703-1472
Mailing Address - Fax:405-703-1653
Practice Address - Street 1:2305 S. I-35 SERVICE ROAD
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2775
Practice Address - Country:US
Practice Address - Phone:405-703-1472
Practice Address - Fax:405-703-1653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200047670AMedicaid
6065470001Medicare NSC