MEDICARE: OKLAHOMA SPORTS AND ORTHOPEDICS INSTITUTE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1306211982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA SPORTS AND ORTHOPEDICS INSTITUTE PLLC

Provider Business Mailing Address
First Line	:	3400 W TECUMSEH RD
Second Line	:	STE. 101
City	:	NORMAN
State	:	OK
Zip	:	73072-1810
Country	:	US
Telephone Number	:	405-360-6764
Fax Number	:	405-360-6769

Provider Business Practice Location Address
First Line	:	1624 MIDTOWN PL
Second Line	:	SUITE A
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-6347
Country	:	US
Telephone Number	:	405-360-6764
Fax Number	:	405-360-6769

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	RICHARD A KIRKPATRICK
Credential	:	M.D.
Telephone Number	:	405-360-6764

Provider Enumeration Date	:	12/08/2015
Last Update Date	:	10/19/2016

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