Provider Demographics
NPI:1003470501
Name:BRETT WHATCOTT DO PLLC
Entity Type:Organization
Organization Name:BRETT WHATCOTT DO PLLC
Other - Org Name:OKLAHOMA PAIN SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEINE
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:479-431-6990
Mailing Address - Street 1:2707 MARKET TRACE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908
Mailing Address - Country:US
Mailing Address - Phone:479-434-3600
Mailing Address - Fax:479-434-3602
Practice Address - Street 1:2707 MARKET TRACE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908
Practice Address - Country:US
Practice Address - Phone:479-434-3600
Practice Address - Fax:479-434-3602
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRETT WHATCOTT DO PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-30
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5515OtherLICENSE
ARE-2230OtherLICENSE