Healthcare Provider Details

I. General information

NPI: 1548620529
Provider Name (Legal Business Name): ORTHO PLUS HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 S WESTERN AVE STE A3
OKLAHOMA CITY OK
73170-6085
US

IV. Provider business mailing address

301 LILAC DR STE 140
EDMOND OK
73034-7288
US

V. Phone/Fax

Practice location:
  • Phone: 56-768-6434
  • Fax: 405-676-8644
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number19051
License Number StateOK

VIII. Authorized Official

Name: BRENT K HOLLIMAN
Title or Position: OFFICER
Credential:
Phone: 405-285-2994