=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649401241
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EPIC ORTHOPEDICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2009
-----------------------------------------------------
Last Update Date | 07/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 909 SUMMIT RIDGE DR.
-----------------------------------------------------
City | MCALESTER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-916-4400
-----------------------------------------------------
Fax | 918-421-8737
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 909 SUMMIT RIDGE DR.
-----------------------------------------------------
City | MCALESTER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-916-4400
-----------------------------------------------------
Fax | 918-421-8737
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHAD EDWARD CRAWLEY
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 918-916-4400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 4449
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------