Provider Demographics
NPI:1427292465
Name:SOUTH OKLAHOMA ORTHOPEDICS INC.
Entity type:Organization
Organization Name:SOUTH OKLAHOMA ORTHOPEDICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-682-5351
Mailing Address - Street 1:2149 S.W. 59TH
Mailing Address - Street 2:102
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73119
Mailing Address - Country:US
Mailing Address - Phone:405-682-5351
Mailing Address - Fax:405-685-5563
Practice Address - Street 1:2149 SW 59TH ST
Practice Address - Street 2:102
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7033
Practice Address - Country:US
Practice Address - Phone:405-682-5351
Practice Address - Fax:405-685-5563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1601207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100042570AMedicaid
281323502Medicare PIN
E16465Medicare UPIN