Organization
INTERVENTIONAL SPINE SERVICES- III
Active
Other names
INTERVENTIONAL SPINE SERVICES- II
Organization subpart
No
Provider details
NPI number
Authorized official
EMILI GRAGG (MANAGER)
(405) 219-2651
Entity
Organization
Contact information
Practice address
1907 N BROADWAY AVE STE B, OKLAHOMA CITY, OK 73103-4407
(405) 702-7246
(405) 609-6679
Mailing address
PO BOX 152, OKLAHOMA CITY, OK 73101-0152
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
07/10/2025
Last updated
07/10/2025
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