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General NPI Number Information
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NPI Number | 1316010150
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC CENTER OF MUSKOGEE
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 3900 WEST BROADWAY
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City | MUSKOGEE
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State | OK
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Zip | 74401
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Country | US
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Telephone | 918-686-6600
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Fax | 918-686-6601
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Provider Business Mailing Address
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Address Line | 3900 WEST BROADWAY
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City | MUSKOGEE
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State | OK
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Zip | 74401
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Country | US
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Telephone | 918-686-6600
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Fax | 918-686-6601
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Authorized Official
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Title or Position | DOCTOR
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Name | CLINT FOREST KIRK
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Credential | DO
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Telephone | 918-686-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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