# EAGLE COMMUNITY CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** OKLAHOMA SPORTS AND ORTHOPEDICS INSTITUTE PLLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1063790202
- **Legal business name:** OKLAHOMA SPORTS AND ORTHOPEDICS INSTITUTE PLLC
- **Authorized official:** BRANDON L PENICK (DIRECTOR OF REIMBURSEMENT)
- **Authorized official phone:** (405) 360-6764

## Contact information

- **Practice address:** 13800 BENSON RD, 202, EDMOND, OK 73013-6422
- **Practice address phone:** (405) 418-3077
- **Practice address fax:** (405) 418-3076
- **Mailing address:** PO BOX 5995, NORMAN, OK 73070-5995
- **Mailing address phone:** (405) 360-6764
- **Mailing address fax:** (405) 360-6769

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/21/2011
- **Last updated:** 07/21/2011