Provider Demographics
NPI:1073992889
Name:COMPREHENSIVE PAIN MANAGEMENT OF OKLAHOMA, P.L.L.C.
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN MANAGEMENT OF OKLAHOMA, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-568-2593
Mailing Address - Street 1:432 S MUSTANG RD STE A
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-7312
Mailing Address - Country:US
Mailing Address - Phone:405-467-4399
Mailing Address - Fax:405-467-4481
Practice Address - Street 1:432 S MUSTANG RD STE A
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7312
Practice Address - Country:US
Practice Address - Phone:405-467-4399
Practice Address - Fax:405-467-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4373208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200593290BMedicaid