Organization
OKLAHOMA SPINE DIAGNOSTIC AND PAIN TREATMENT CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELENIE NACHIMSON (CREDENTIALING SPECIALIST)
(405) 775-9350
Entity
Organization
Contact information
Practice address
3200 MEDICAL PARK DR, SHAWNEE, OK 74804-5014
(405) 878-9490
(405) 878-9492
Mailing address
PO BOX 14459, OKLAHOMA CITY, OK 73113-0459
(405) 775-9350
(405) 775-9360
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
19113
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200119720A
—
OK
01
—
6252130001
DME - CIGNA GOVERNMENT SERVICES
OK
01
—
DH1384
MEDICARE RR
OK
Enumeration date
02/19/2007
Last updated
12/19/2012
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