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Contact Information

OKLAHOMA SPINE DIAGNOSTIC AND PAIN TREATMENT CENTER PLLC
3200 MEDICAL PARK DR
SHAWNEE, OK74804-5014
 Phone: 405-878-9490
 Fax: 405-878-9492
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Interventional Pain Medicine

208VP0014X 09 Physician/Interventional Pain Management
Indicates primary specialty

NPI Profile & details for OKLAHOMA SPINE DIAGNOSTIC AND PAIN TREATMENT CENTER PLLC · (Female)

NPI # 1841334166
Status Active
Credentials
Entity Individual
Enumeration date 02/19/2007
Last updated 12/19/2012 - About 13 years ago
Sole proprietor 1 Not specified
Identifiers
  • OK License # 19113
  • OK Medicaid 200119720A
  • OK Other 6252130001 DME - CIGNA GOVERNMENT SERVICES
  • OK Other DH1384 MEDICARE RR
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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