Provider Demographics
NPI:1235252115
Name:OKLAHOMA CITY PAIN MANAGEMENT PLLC
Entity Type:Organization
Organization Name:OKLAHOMA CITY PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PUSHPA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMBI JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-608-0823
Mailing Address - Street 1:4205 MCAULEY BLVD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9391
Mailing Address - Country:US
Mailing Address - Phone:405-608-0823
Mailing Address - Fax:405-608-0824
Practice Address - Street 1:4205 MCAULEY BLVD
Practice Address - Street 2:SUITE 470
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9391
Practice Address - Country:US
Practice Address - Phone:405-608-0823
Practice Address - Fax:405-608-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24655207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG71799Medicare UPIN