Provider Demographics
NPI:1447648092
Name:MIDTOWN ORTHOPEDICS AND SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:MIDTOWN ORTHOPEDICS AND SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-272-8326
Mailing Address - Street 1:400 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-3711
Mailing Address - Country:US
Mailing Address - Phone:405-272-8326
Mailing Address - Fax:405-272-7963
Practice Address - Street 1:400 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3711
Practice Address - Country:US
Practice Address - Phone:405-272-8326
Practice Address - Fax:405-272-7963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty