Provider Demographics
NPI:1407063266
Name:NORTHWEST OKLAHOMA ORTHOPAEDIC CLINIC INC
Entity type:Organization
Organization Name:NORTHWEST OKLAHOMA ORTHOPAEDIC CLINIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-233-6707
Mailing Address - Street 1:PO BOX 1484
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-1484
Mailing Address - Country:US
Mailing Address - Phone:580-233-6707
Mailing Address - Fax:580-233-3724
Practice Address - Street 1:900 W CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5410
Practice Address - Country:US
Practice Address - Phone:580-233-6707
Practice Address - Fax:580-233-3724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100730140DMedicaid
OK100730140CMedicaid