Southeastern Oklahoma Sports Medicine, PLLC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

24887 Issued in OK

Legal business name

SOUTHEASTERN OKLAHOMA SPORTS MEDICINE, PLLC

Practice address

1705 N Washington Ave
Suite C
Durant, OK 74701-2100

Phone

(580) 924-1414

Fax

(580) 931-0300

NPI assigned

Apr 23, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brian K Rich, M.D.

Title

President

Phone

(580) 924-1414

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271980800000",
    "number": "1124345665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 N WASHINGTON AVE",
            "address_2": "SUITE C",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747012100",
            "telephone_number": "580-924-1414",
            "fax_number": "580-931-0300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 N WASHINGTON AVE",
            "address_2": "SUITE C",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747012100",
            "telephone_number": "580-924-1414",
            "fax_number": "580-931-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN OKLAHOMA SPORTS MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-23",
        "last_updated": "2010-04-23",
        "status": "A",
        "authorized_official_last_name": "RICH",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "580-924-1414",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "OK",
            "license": "24887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "24887",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1063436947",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristy M Smothers, ARNP
• Jaylon Sneed, COTA
• Southeastern Oklahoma Eye Clinic
• Southeastern Oklahoma Family Services
• Southeastern Oklahoma Family Services, Inc.
• Southeastern Pediatrics, PLLC
• Hazel Mae Southerland, LPC
• Southern Oklahoma Treatment Services, Inc.
• Southern Oklahoma Treatment Services, Inc.
• Southern Oklahoma Treatment Services, Inc.

• All providers in Durant, OK
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.