Organization
PRECISION PAIN MANAGEMENT OF OKLAHOMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA BRISCOE (CONTRACTING SPECIALIST)
(918) 893-9445
Entity
Organization
Contact information
Practice address
4110 S. 100TH E. AVE., STE 201, TULSA, OK 74146-6936
(918) 857-7246
(918) 359-5828
Mailing address
4110 S 100TH E. AVE., STE. 74146, TULSA, OK 74136-3311
(918) 857-7246
(918) 359-5828
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
—
OK
363LF0000X
Family Nurse Practitioner
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200556740A
—
OK
01
—
OK378052
MEDICARE GROUP PTAN
OK
Enumeration date
01/30/2014
Last updated
04/29/2016
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