# ORA ORTHOPEDICS PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ORA ORTHOPEDICS, PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1023089323
- **Legal business name:** ORA ORTHOPEDICS, PC
- **Authorized official:** KENNETH BROCKMAN (CEO)
- **Authorized official phone:** (563) 322-0971

## Contact information

- **Practice address:** 1225 S OAKWOOD AVE STE 7B, GENESEO, IL 61254-1990
- **Practice address phone:** (309) 762-3621
- **Practice address fax:** (309) 762-3690
- **Mailing address:** 520 VALLEY VIEW DR, MOLINE, IL 61265-6194
- **Mailing address phone:** (309) 762-3621
- **Mailing address fax:** (309) 762-3690

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WM0705X | Medical-Surgical Registered Nurse | — | NULL | — |
| 163WM0705X | Medical-Surgical Registered Nurse | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | 060006850 | IL | Yes |
| 246Z00000X | Other Specialist/Technologist | — | NULL | — |
| 246Z00000X | Other Specialist/Technologist | — | — | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/27/2006
- **Last updated:** 04/29/2024