Provider Demographics
NPI:1447045976
Name:WESTERN OKLAHOMA PAIN SPECIALISTS LLC
Entity type:Organization
Organization Name:WESTERN OKLAHOMA PAIN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-339-8001
Mailing Address - Street 1:PO BOX 659506
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-9506
Mailing Address - Country:US
Mailing Address - Phone:580-339-8001
Mailing Address - Fax:580-339-8031
Practice Address - Street 1:14041 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5586
Practice Address - Country:US
Practice Address - Phone:580-339-8001
Practice Address - Fax:580-339-8031
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN OKLAHOMA PAIN SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty