Healthcare Provider Details

I. General information

NPI: 1912978214
Provider Name (Legal Business Name): ORA ORTHOPEDICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W LOMBARD ST
DAVENPORT IA
52804-2148
US

IV. Provider business mailing address

2300 53RD AVE SUITE 100
BETTENDORF IA
52722-7564
US

V. Phone/Fax

Practice location:
  • Phone: 563-322-0971
  • Fax: 563-324-0615
Mailing address:
  • Phone: 563-322-0971
  • Fax: 563-324-0615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number060006850
License Number StateIL

VIII. Authorized Official

Name: KENNETH BROCKMAN
Title or Position: CEO
Credential:
Phone: 563-322-0971