Organization
MEDICAL CENTER PAIN CLINIC, PLLC
Active
Organization
MEDICAL CENTER PAIN CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID PAUL ELLIS MD (REGISTERED AGENT)
(405) 232-8003
Entity
Organization
Contact information
Practice address
1226 N SHARTEL AVE, SUITE 300, OKLAHOMA CITY, OK 73103
(405) 232-8003
(405) 232-8808
Mailing address
2700 NE 63RD ST, OKLAHOMA CITY, OK 73111-8305
(405) 271-5859
(405) 232-8808
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
15874
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200432890A
—
OK
Enumeration date
03/22/2012
Last updated
07/14/2018
Update your record
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