Healthcare Provider Details

I. General information

NPI: 1477971315
Provider Name (Legal Business Name): THE ORTHOPAEDIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 S 101ST EAST AVE SUITE 100
TULSA OK
74133-5726
US

IV. Provider business mailing address

1809 E 13TH ST SUITE 100
TULSA OK
74104-4419
US

V. Phone/Fax

Practice location:
  • Phone: 918-301-3160
  • Fax:
Mailing address:
  • Phone: 918-582-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN CLARY
Title or Position: CEO
Credential:
Phone: 918-925-3224