Healthcare Provider Details

I. General information

NPI: 1235316829
Provider Name (Legal Business Name): ORTHOPEDIC & TRAUMA SERVICE OF OKLAHOMA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 S YALE AVE STE 525
TULSA OK
74135-7485
US

IV. Provider business mailing address

5110 S YALE AVE STE 525
TULSA OK
74135-7485
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-4547
  • Fax: 918-392-4555
Mailing address:
  • Phone: 918-392-4547
  • Fax: 918-392-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateOK

VIII. Authorized Official

Name: BETSY WEBB
Title or Position: OFFICE MANAGER
Credential:
Phone: 918-392-4547