MEDICARE: NORTHEAST ORHTOPAEDICS & SPORTS MEDICINE

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306968839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST ORHTOPAEDICS & SPORTS MEDICINE

Provider Business Mailing Address
First Line	:	6312 E 101ST STREET
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-5726
Country	:	US
Telephone Number	:	918-701-2000
Fax Number	:	918-893-6202

Provider Business Practice Location Address
First Line	:	6312 E 101ST STREET
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137
Country	:	US
Telephone Number	:	918-701-2000
Fax Number	:	918-893-6202

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JERRY J COLE
Credential	:	D.O.
Telephone Number	:	918-701-2000

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	11/25/2015

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Directions to “NORTHEAST ORHTOPAEDICS & SPORTS MEDICINE ” Practice Location

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