Provider Demographics
NPI:1518345248
Name:OKLAHOMA SPINE HOSPITAL LLC
Entity Type:Organization
Organization Name:OKLAHOMA SPINE HOSPITAL LLC
Other - Org Name:OSH PHYSICIAN GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/AO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAYLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-749-2700
Mailing Address - Street 1:4013 NW EXPRESSWAY STE 610
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-2610
Mailing Address - Country:US
Mailing Address - Phone:405-833-4227
Mailing Address - Fax:405-241-5298
Practice Address - Street 1:14101 PARKWAY COMMONS DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-6012
Practice Address - Country:US
Practice Address - Phone:405-775-4241
Practice Address - Fax:405-841-9385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty