Provider Demographics
NPI:1376862771
Name:OKLAHOMA PAIN AND WELLNESS CENTER, PLC
Entity Type:Organization
Organization Name:OKLAHOMA PAIN AND WELLNESS CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAYEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-935-3240
Mailing Address - Street 1:2811 E 15TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5242
Mailing Address - Country:US
Mailing Address - Phone:918-935-3240
Mailing Address - Fax:918-935-3241
Practice Address - Street 1:2811 E 15TH ST STE 102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5242
Practice Address - Country:US
Practice Address - Phone:918-935-3240
Practice Address - Fax:918-935-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200294580AMedicaid