MEDICARE: ORTHOPAEDIC & SPORTS SPECIALISTS PC

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	R4C36	MO
2	207X00000X	Orthopaedic Surgery Physician	H1505	TX
3	207X00000X	Orthopaedic Surgery Physician	13864	OK

General Provider Information

NPI Number	:	1679567960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPAEDIC & SPORTS SPECIALISTS PC

Provider Business Mailing Address
First Line	:	4140 W MEMORIAL RD
Second Line	:	PLAZA 308
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8366
Country	:	US
Telephone Number	:	405-749-7031
Fax Number	:	405-749-7036

Provider Business Practice Location Address
First Line	:	4140 W MEMORIAL RD
Second Line	:	PLAZA 308
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8366
Country	:	US
Telephone Number	:	405-749-7031
Fax Number	:	405-749-7036

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. CATHY ANN JOHNS
Credential	:
Telephone Number	:	405-749-7031

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	05/21/2009

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