Healthcare Provider Details

I. General information

NPI: 1255965224
Provider Name (Legal Business Name): ORTHOPEDIC FOOT AND ANKLE SURGICAL ASSIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 RENAISSANCE BLVD STE 210
EDMOND OK
73013-3023
US

IV. Provider business mailing address

PO BOX 2378
EDMOND OK
73083-2378
US

V. Phone/Fax

Practice location:
  • Phone: 210-598-4262
  • Fax: 405-768-1601
Mailing address:
  • Phone: 405-768-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JOEL DAVIS
Title or Position: OWNER
Credential:
Phone: 405-768-1600