Provider Demographics
NPI:1649771874
Name:PMO MEDICAL PLLC
Entity Type:Organization
Organization Name:PMO MEDICAL PLLC
Other - Org Name:PAIN MANAGEMENT OF OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-794-6008
Mailing Address - Street 1:701 W QUEENS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1785
Mailing Address - Country:US
Mailing Address - Phone:918-794-6008
Mailing Address - Fax:918-516-3447
Practice Address - Street 1:401 E BROADWAY CT STE A
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-7931
Practice Address - Country:US
Practice Address - Phone:918-246-3456
Practice Address - Fax:918-516-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200618300Medicaid