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General NPI Number Information
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NPI Number | 1255965224
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC FOOT AND ANKLE SURGICAL ASSIST, LLC
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Dates
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Enumeration Date | 02/27/2020
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 1800 RENAISSANCE BLVD STE 210
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City | EDMOND
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State | OK
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Zip | 73013-3023
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Country | US
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Telephone | 210-598-4262
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Fax | 405-768-1601
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Provider Business Mailing Address
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Address Line | PO BOX 2378
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City | EDMOND
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State | OK
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Zip | 73083-2378
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Country | US
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Telephone | 405-768-1600
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOEL DAVIS
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Credential |
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Telephone | 405-768-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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