Healthcare Provider Details

I. General information

NPI: 1942659982
Provider Name (Legal Business Name): ORTHOPEDIC SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S SAINTS BLVD SUITE 101
EDMOND OK
73034-3081
US

IV. Provider business mailing address

101 S SAINTS BLVD SUITE 101
EDMOND OK
73034-3081
US

V. Phone/Fax

Practice location:
  • Phone: 405-513-8326
  • Fax:
Mailing address:
  • Phone: 405-513-8326
  • Fax: 405-844-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN HARGROVE
Title or Position: SOLE MEMBER
Credential: M.D.
Phone: 405-513-8326