Provider Demographics
NPI:1699863399
Name:METRO TULSA FOOT & ANKLE SPECIALISTS PLLC
Entity type:Organization
Organization Name:METRO TULSA FOOT & ANKLE SPECIALISTS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:918-494-2902
Mailing Address - Street 1:PO BOX 268860
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8860
Mailing Address - Country:US
Mailing Address - Phone:918-272-8920
Mailing Address - Fax:918-272-8922
Practice Address - Street 1:10229 E 96TH ST N
Practice Address - Street 2:SUITE 100
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-5305
Practice Address - Country:US
Practice Address - Phone:918-272-8920
Practice Address - Fax:918-272-8922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100685820CMedicaid
OK620980735Medicare PIN
OK1168810003Medicare NSC