Organization
CENTRAL STATES ORTHOPEDIC SPECIALISTS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID R. LONG (ADMINISTRATOR CEO)
(918) 481-7644
Entity
Organization
Contact information
Practice address
6585 S YALE AVE, STE 200, TULSA, OK 74136-8384
(918) 481-2767
(918) 481-7639
Mailing address
6585 S YALE AVE, STE 200, TULSA, OK 74136-8384
(918) 481-2767
(918) 481-7639
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
332900000X
Non-Pharmacy Dispensing Site
18573
OK
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100031720A
—
OK
01
—
3724437
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/23/2005
Last updated
10/15/2011
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