Provider Demographics
NPI:1437866886
Name:UNIFIED PAIN GROUP LLC
Entity Type:Organization
Organization Name:UNIFIED PAIN GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:405-550-3618
Mailing Address - Street 1:1211 N SHARTEL AVE STE 900
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2477
Mailing Address - Country:US
Mailing Address - Phone:405-596-5916
Mailing Address - Fax:
Practice Address - Street 1:1211 N SHARTEL AVE STE 900
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2477
Practice Address - Country:US
Practice Address - Phone:405-596-5916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain