Healthcare Provider Details

I. General information

NPI: 1780770651
Provider Name (Legal Business Name): OKLAHOMA ORTHOPEDIC INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 24TH AVE NW SUITE 100
NORMAN OK
73069-6341
US

IV. Provider business mailing address

1020 24TH AVE NW SUITE 100
NORMAN OK
73069-6341
US

V. Phone/Fax

Practice location:
  • Phone: 405-447-4999
  • Fax: 405-447-5608
Mailing address:
  • Phone: 405-447-4999
  • Fax: 405-447-5608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20902
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2243
License Number StateOK

VIII. Authorized Official

Name: DR. TOM WALLACE EWING
Title or Position: PRESIDENT
Credential: DO
Phone: 405-447-4999