Provider Demographics
NPI:1972872448
Name:OKLAHOMA MEDICAL PAIN MANAGEMENT
Entity Type:Organization
Organization Name:OKLAHOMA MEDICAL PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-219-5856
Mailing Address - Street 1:107006 N 3600 RD
Mailing Address - Street 2:
Mailing Address - City:PADEN
Mailing Address - State:OK
Mailing Address - Zip Code:74860-7101
Mailing Address - Country:US
Mailing Address - Phone:405-932-1234
Mailing Address - Fax:405-932-1248
Practice Address - Street 1:1230 SW 89TH ST STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-9106
Practice Address - Country:US
Practice Address - Phone:405-703-8860
Practice Address - Fax:405-900-4985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4354208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200080670AMedicaid