MEDICARE: ORTHOPAEDIC AND SPORTS MEDICINE CENTER-NORMAN, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1366228439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPAEDIC AND SPORTS MEDICINE CENTER-NORMAN, P.C.

Provider Business Mailing Address
First Line	:	825 E ROBINSON ST
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73071-6610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 S DOUGLAS BLVD STE D
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5265
Country	:	US
Telephone Number	:	405-364-7900
Fax Number	:	405-366-6214

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	EMILY WAINNER
Credential	:
Telephone Number	:	405-310-6881

Provider Enumeration Date	:	09/05/2023
Last Update Date	:	03/25/2024

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