Provider Demographics
NPI:1588625339
Name:OKLAHOMA SPINE AND BRAIN INSTITUTE
Entity Type:Organization
Organization Name:OKLAHOMA SPINE AND BRAIN INSTITUTE
Other - Org Name:NEUROSURGERY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:G
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-749-0762
Mailing Address - Street 1:6802 S OLYMPIA AVE
Mailing Address - Street 2:STE300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1823
Mailing Address - Country:US
Mailing Address - Phone:918-749-0762
Mailing Address - Fax:918-744-4246
Practice Address - Street 1:6802 S OLYMPIA AVE
Practice Address - Street 2:STE300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1823
Practice Address - Country:US
Practice Address - Phone:918-749-0762
Practice Address - Fax:918-744-4246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15858174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKCS2244OtherRAILROAD MEDICARE
OK100729760AMedicaid
OK100729760AMedicaid