Organization
NEUROSCIENCE SPECIALISTS PC
Active
Organization
NEUROSCIENCE SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICHOLAS MCCOLLUM (DIRECTOR OF TECHNOLOGY)
(405) 748-3300
Entity
Organization
Contact information
Practice address
14100 PARKWAY COMMONS DR STE 100, OKLAHOMA CITY, OK 73134-6036
(405) 748-3300
(405) 749-1671
Mailing address
14100 PARKWAY COMMONS DR STE 100, OKLAHOMA CITY, OK 73134-6036
(405) 748-3300
(405) 749-1671
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
—
—
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
—
—
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100746190A
—
OK
01
—
CN6921
MEDICARE RAILROAD
OK
Enumeration date
03/14/2006
Last updated
02/02/2022
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