# GENESIS MEDICAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Oklahoma Pain Management
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235050089
- **Authorized official:** SHERRY LYNNE CLARK (BILLING/CREDENTIALING)
- **Authorized official phone:** (580) 223-5180

## Contact information

- **Practice address:** 1100 CRADDUCK RD, ADA, OK 74820
- **Practice address phone:** (580) 221-2022
- **Practice address fax:** (580) 221-2024
- **Mailing address:** 1100 CRADDUCK RD, ADA, OK 74820
- **Mailing address phone:** (580) 221-2022
- **Mailing address fax:** (580) 221-2024

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/24/2026
- **Last updated:** 07/24/2026