Provider Demographics
NPI:1982194908
Name:GLENPOOL PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:GLENPOOL PAIN MANAGEMENT LLC
Other - Org Name:GLENPOOL PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARRICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:KLUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-321-2719
Mailing Address - Street 1:148 W MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-3952
Mailing Address - Country:US
Mailing Address - Phone:918-321-2719
Mailing Address - Fax:
Practice Address - Street 1:148 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033
Practice Address - Country:US
Practice Address - Phone:918-321-2719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty