Healthcare Provider Details

I. General information

NPI: 1093620197
Provider Name (Legal Business Name): ORTHO STAT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N EASTERN AVE
MOORE OK
73160-5833
US

IV. Provider business mailing address

PO BOX 891625
OKLAHOMA CITY OK
73189-1625
US

V. Phone/Fax

Practice location:
  • Phone: 405-237-3326
  • Fax: 405-349-4017
Mailing address:
  • Phone: 405-237-3326
  • Fax: 405-349-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: LESLEY HENTHORN
Title or Position: CREDENTIALING
Credential: CREDENTIALING
Phone: 405-237-3770