Provider Demographics
NPI:1477736445
Name:ADVANCED PAIN SOLUTIONS
Entity Type:Organization
Organization Name:ADVANCED PAIN SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SOMERVILLE
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:405-947-8293
Mailing Address - Street 1:PO BOX 57079
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73157-7079
Mailing Address - Country:US
Mailing Address - Phone:405-947-8293
Mailing Address - Fax:
Practice Address - Street 1:4115 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2421
Practice Address - Country:US
Practice Address - Phone:405-947-8293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty