=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134316912
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROGRESSIVE ORTHOTIC & PROSTHETIC SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2007
-----------------------------------------------------
Last Update Date | 06/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1631 SE WASHINGTON BLVD
-----------------------------------------------------
City | BARTLESVILLE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74006-4933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-786-7701
-----------------------------------------------------
Fax | 918-786-7708
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PROGRESSIVE ORTHOTICS & PROSTHETICS SERVICES INC- 9511 E. 46TH ST
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74145-2007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-786-7707
-----------------------------------------------------
Fax | 918-786-7705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATION
-----------------------------------------------------
Name | BETTY CLEMENT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 417-621-0055
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | 5
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------