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Organization

SHETH PAIN CENTER PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MELENIE NACHIMSON (CREDENTIALING SPECIALIST)
(405) 775-9350
Entity
Organization

Contact information

Practice address
4200 W MEMORIAL RD, 305, OKLAHOMA CITY, OK 73120-9350
(405) 841-7899
(405) 775-9360
Mailing address
PO BOX 108835, OKLAHOMA CITY, OK 73101-8835
(405) 775-9350
(405) 775-9360

Taxonomy

Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
14599
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200103130A
OK
01
612084900
DOL
OK
01
DG2424
MEDICARE RR
OK
Enumeration date
12/19/2006
Last updated
05/19/2011
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