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General NPI Number Information
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NPI Number | 1821975764
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Entity Type | Organization
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Legal Business Name | ARDMORE ORTHO PLUS, LLC
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 08/20/2025
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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 | 405-216-3743
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Authorized Official
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Title or Position | MANAGER
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Name | BRENT KEITH HOLLIMAN
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Credential | PA
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Telephone | 580-226-7587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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