Provider Demographics
NPI:1841489333
Name:PAIN DIAGNOSIS AND TREATMENT CENTER, PLLC
Entity type:Organization
Organization Name:PAIN DIAGNOSIS AND TREATMENT CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BHADRESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-369-5511
Mailing Address - Street 1:8556 E 101ST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7033
Mailing Address - Country:US
Mailing Address - Phone:918-369-5511
Mailing Address - Fax:918-369-5512
Practice Address - Street 1:8556 E 101ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7033
Practice Address - Country:US
Practice Address - Phone:918-369-5511
Practice Address - Fax:918-369-5512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100522129Medicare PIN