Healthcare Provider Details

I. General information

NPI: 1821051566
Provider Name (Legal Business Name): CENTRAL STATES ORTHOPEDIC SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6585 S YALE AVE 200
TULSA OK
74136-8384
US

IV. Provider business mailing address

6585 S YALE AVE SUITE 200
TULSA OK
74136-8384
US

V. Phone/Fax

Practice location:
  • Phone: 918-481-2767
  • Fax: 918-481-7611
Mailing address:
  • Phone: 918-481-2767
  • Fax: 918-481-7611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateOK
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateOK

VIII. Authorized Official

Name: SARAH FOX
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 918-481-7616