Provider Demographics
NPI:1770171605
Name:UPTOWN PAIN MANAGEMENT
Entity type:Organization
Organization Name:UPTOWN PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IHAB
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:KAYELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-749-1187
Mailing Address - Street 1:13236 N. 7TH ST.
Mailing Address - Street 2:STE 4 #289
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022
Mailing Address - Country:US
Mailing Address - Phone:918-218-2041
Mailing Address - Fax:
Practice Address - Street 1:1844 E 15TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4611
Practice Address - Country:US
Practice Address - Phone:918-218-2041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain