Provider Demographics
NPI:1649331588
Name:ROCKY MOUNTAIN ORTHOPAEDIC SURGERY PC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN ORTHOPAEDIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:WHITTINGTON
Authorized Official - Last Name:OGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-786-9070
Mailing Address - Street 1:2642 SHASTEN ST
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-4904
Mailing Address - Country:US
Mailing Address - Phone:918-786-9070
Mailing Address - Fax:918-786-9188
Practice Address - Street 1:2642 SHASTEN ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-4904
Practice Address - Country:US
Practice Address - Phone:918-786-9070
Practice Address - Fax:918-786-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40378207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty