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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

NPI # 1841334166
LBN Legal business name OKLAHOMA SPINE DIAGNOSTIC AND PAIN TREATMENT CENTER PLLC
Authorized official MELENIE NACHIMSON - (CREDENTIALING SPECIALIST)
Entity Organization
Organization subpart 1 No
Enumeration date 02/19/2007
Last updated 12/19/2012 - About 13 years ago
Identifiers
OK License # 19113
OK Medicaid 200119720A
OK Other 6252130001 DME - CIGNA GOVERNMENT SERVICES
OK Other DH1384 MEDICARE RR
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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