Provider Demographics
NPI:1699311308
Name:ACELLERATED INTERVENTIONAL ORTHOPEDICS
Entity type:Organization
Organization Name:ACELLERATED INTERVENTIONAL ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-771-2011
Mailing Address - Street 1:4020 N MACARTHUR BLVD STE 122-321
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-6419
Mailing Address - Country:US
Mailing Address - Phone:580-771-2011
Mailing Address - Fax:580-292-3457
Practice Address - Street 1:1002 NE HIGHWAY 66 STE 3
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:OK
Practice Address - Zip Code:73662-9312
Practice Address - Country:US
Practice Address - Phone:580-771-2011
Practice Address - Fax:580-292-3457
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACELLERATED INTERVENTIONAL ORTHOPEDICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200093580AMedicaid