Organization
CLINILOGIC LLC
Active
Other names
Advanced Pain Management
Organization subpart
No
Provider details
NPI number
Authorized official
RITA PANNELL (REV CYCLE MGR)
(214) 310-6763
Entity
Organization
Contact information
Practice address
3727 NW 63RD ST STE 302, OKLAHOMA CITY, OK 73116-1931
(405) 702-8623
(405) 608-8623
Mailing address
2701 LITTLE ELM PKWY STE 100-148, LITTLE ELM, TX 75068-6672
(214) 310-6763
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200844440A
—
OK
Enumeration date
05/30/2018
Last updated
07/29/2019
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