Provider Demographics
NPI:1255941423
Name:PROCEDURAL PAIN MANAGEMENT LLC
Entity type:Organization
Organization Name:PROCEDURAL PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LADD
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-298-8080
Mailing Address - Street 1:9906 RIVERSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7409
Mailing Address - Country:US
Mailing Address - Phone:918-298-8080
Mailing Address - Fax:
Practice Address - Street 1:9906 RIVERSIDE PKWY
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7409
Practice Address - Country:US
Practice Address - Phone:918-298-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty