Provider Demographics
NPI:1487992749
Name:OKLAHOMA SPORTS AND ORTHOPEDICS INSTITUTE PLLC
Entity type:Organization
Organization Name:OKLAHOMA SPORTS AND ORTHOPEDICS INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:PENICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-928-7992
Mailing Address - Street 1:3400 W TECUMSEH RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1810
Mailing Address - Country:US
Mailing Address - Phone:405-360-6764
Mailing Address - Fax:405-360-6769
Practice Address - Street 1:13500 S TULSA DR
Practice Address - Street 2:SUITE 301
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-9704
Practice Address - Country:US
Practice Address - Phone:405-793-2901
Practice Address - Fax:405-360-6769
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OKLAHOMA SPORTS AND ORTHOPEDICS INSTITUTE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center