Provider Demographics
NPI:1871616490
Name:STILLWATER ORTHOPAEDIC CLINIC INC.
Entity type:Organization
Organization Name:STILLWATER ORTHOPAEDIC CLINIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-707-7500
Mailing Address - Street 1:320 N PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-5513
Mailing Address - Country:US
Mailing Address - Phone:405-707-7500
Mailing Address - Fax:405-707-9948
Practice Address - Street 1:320 N PERKINS RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-5513
Practice Address - Country:US
Practice Address - Phone:405-707-7500
Practice Address - Fax:405-707-9948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0573870001Medicare NSC
OK400522230Medicare PIN