Provider Demographics
NPI:1881272656
Name:OKLAHOMA OUTPATIENT PAIN AND SPINE CENTER LLC
Entity type:Organization
Organization Name:OKLAHOMA OUTPATIENT PAIN AND SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-760-4671
Mailing Address - Street 1:3601 NW 138TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2517
Mailing Address - Country:US
Mailing Address - Phone:405-760-4671
Mailing Address - Fax:
Practice Address - Street 1:13313 N MERIDIAN AVE STE B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8316
Practice Address - Country:US
Practice Address - Phone:405-760-4671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty