# STONE BLUFF MEDICAL, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942129663
- **Authorized official:** IAN KELLEY (SOLE MEMBER)
- **Authorized official phone:** (918) 633-0447

## Contact information

- **Practice address:** 2028 MAHANEY AVE, TAHLEQUAH, OK 74464-5783
- **Practice address phone:** (918) 992-6050
- **Practice address fax:** (833) 763-2349
- **Mailing address:** 2028 MAHANEY AVE, TAHLEQUAH, OK 74464-5783
- **Mailing address phone:** (918) 992-6050
- **Mailing address fax:** (833) 763-2349

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208VP0000X | Pain Medicine Physician | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/15/2026
- **Last updated:** 07/15/2026