Healthcare Provider Details

I. General information

NPI: 1407516339
Provider Name (Legal Business Name): ANDERSON SPORTS MEDICINE AND ORTHOPEDIC CENTER, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 N WESTERN AVE STE 200
OKLAHOMA CITY OK
73114-1431
US

IV. Provider business mailing address

13100 N WESTERN AVE STE 200
OKLAHOMA CITY OK
73114-1431
US

V. Phone/Fax

Practice location:
  • Phone: 405-418-4500
  • Fax: 405-418-4501
Mailing address:
  • Phone: 405-418-4500
  • Fax: 405-418-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDALL MURRAY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 405-418-4505