Provider Demographics
NPI:1780770651
Name:OKLAHOMA ORTHOPEDIC INSTITUTE
Entity type:Organization
Organization Name:OKLAHOMA ORTHOPEDIC INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-447-4999
Mailing Address - Street 1:1020 24TH AVE NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6341
Mailing Address - Country:US
Mailing Address - Phone:405-447-4999
Mailing Address - Fax:405-447-5608
Practice Address - Street 1:1020 24TH AVE NW
Practice Address - Street 2:SUITE 100
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6341
Practice Address - Country:US
Practice Address - Phone:405-447-4999
Practice Address - Fax:405-447-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK209022081P2900X
OK2243207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100744280AMedicaid
OK100744280AMedicaid
OK0882410002Medicare NSC