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General NPI Number Information
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NPI Number | 1477223451
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Entity Type | Organization
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Legal Business Name | ORTHO PLUS LLC
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 2419 N COMMERCE ST STE B
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City | ARDMORE
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State | OK
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Zip | 73401-1357
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Country | US
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Telephone | 580-226-7587
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Fax | 580-226-4878
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Provider Business Mailing Address
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Address Line | 301 LILAC DR STE 140
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City | EDMOND
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State | OK
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Zip | 73034-7288
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Country | US
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Telephone | 405-906-3375
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | BRENT KEITH HOLLIMAN
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Credential | PA
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Telephone | 405-227-1280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty 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 | 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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