Healthcare Provider Details

I. General information

NPI: 1598847337
Provider Name (Legal Business Name): NORMAN REGIONAL SPORTS & OCCUPATIONAL MEDICIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 24TH AVE NW SUITE # 200
NORMAN OK
73069-6218
US

IV. Provider business mailing address

PO BOX 1330
NORMAN OK
73070-1330
US

V. Phone/Fax

Practice location:
  • Phone: 405-360-6868
  • Fax: 405-360-9860
Mailing address:
  • Phone: 405-360-6868
  • Fax: 405-360-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MEEGAN CARTER
Title or Position: VICE PRESIDENT, REVENUE CYCLE
Credential:
Phone: 405-307-1050