The Orthodox Presbyterian Church was founded in 1936 as a result of theological controversies within the Presbyterian Church in the U.S.A. Since then, the OPC has grown and now has approximately 250 churches and mission works in 39 states (and one Canadian province), organized into 13 regional churches, each governed by a presbytery.

In Presbyterianism the church is governed by elders (presbyters), including ministers. Each congregation chooses its own elders, who are in turn responsible to regional and national assemblies of their peers. The OPC currently has missionaries in China, Eritrea, Ethiopia, Japan, Kenya, Korea, the Middle East, Suriname, and Uganda.

The OPC also has ecumenical ties with the following denominations:

• Associate Reformed Presbyterian Church,
• Evangelical Presbyterian Church of Ireland,
• Free Church of Scotland,
• Presbyterian Church in America (PCA),
• Presbyterian Church in Korea (Kosin),
• Reformed Church in Japan,
• Reformed Church in the U. S.,
• Reformed Churches of New Zealand,
• Reformed Presbyterian Church of Ireland
• Reformed Presbyterian Church of North America (RPCNA).