Organization
OKLAHOMA SPINE DIAGNOSTIC AND PAIN TREATMENT CENTER PLLC
Active
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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