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
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