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General NPI Number Information
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NPI Number | 1093620197
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Entity Type | Organization
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Legal Business Name | ORTHO STAT LLC
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Dates
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Enumeration Date | 08/14/2026
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Last Update Date | 08/14/2026
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Provider Practice Location Address
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Address Line | 400 N EASTERN AVE
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City | MOORE
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State | OK
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Zip | 73160-5833
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Country | US
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Telephone | 405-237-3326
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Fax | 405-349-4017
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Provider Business Mailing Address
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Address Line | PO BOX 891625
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City | OKLAHOMA CITY
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State | OK
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Zip | 73189-1625
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Country | US
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Telephone | 405-237-3326
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Fax | 405-349-4017
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Authorized Official
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Title or Position | CREDENTIALING
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Name | LESLEY HENTHORN
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Credential | CREDENTIALING
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Telephone | 405-237-3770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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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 | 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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