MEDICARE: ORTHOPEDIC AND RECONSTRUCTIVE CENTER P C

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	N/A	OK

General Provider Information

NPI Number	:	1326095068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC AND RECONSTRUCTIVE CENTER P C

Provider Business Mailing Address
First Line	:	1044 SW 44TH ST
Second Line	:	SUITE 600
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3609
Country	:	US
Telephone Number	:	405-631-4263
Fax Number	:	405-631-4891

Provider Business Practice Location Address
First Line	:	1044 SW 44TH ST
Second Line	:	SUITE 600
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3609
Country	:	US
Telephone Number	:	405-631-4263
Fax Number	:	405-631-4891

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	DENNY OREB
Credential	:
Telephone Number	:	405-609-6146

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	04/20/2008

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