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General NPI Number Information
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NPI Number | 1023089323
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Entity Type | Organization
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Legal Business Name | ORA ORTHOPEDICS PC
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 1225 S OAKWOOD AVE STE 7B
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City | GENESEO
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State | IL
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Zip | 61254-1990
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Country | US
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Telephone | 309-762-3621
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Fax | 309-762-3690
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Provider Business Mailing Address
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Address Line | 520 VALLEY VIEW DR
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City | MOLINE
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State | IL
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Zip | 61265-6194
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Country | US
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Telephone | 309-762-3621
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Fax | 309-762-3690
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Authorized Official
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Title or Position | CEO
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Name | KENNETH BROCKMAN
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Credential |
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Telephone | 563-322-0971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 060006850
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License Number State | IL
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