Healthcare Provider Details

I. General information

NPI: 1487992749
Provider Name (Legal Business Name): OKLAHOMA SPORTS AND ORTHOPEDICS INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 S TULSA DR SUITE 301
OKLAHOMA CITY OK
73170-9704
US

IV. Provider business mailing address

3400 W TECUMSEH RD SUITE 101
NORMAN OK
73072-1810
US

V. Phone/Fax

Practice location:
  • Phone: 405-793-2901
  • Fax: 405-360-6769
Mailing address:
  • Phone: 405-360-6764
  • Fax: 405-360-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRANDON L PENICK
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 405-928-7992