Provider Demographics
NPI:1932240041
Name:PAIN MANAGEMENT OF TULSA P C
Entity Type:Organization
Organization Name:PAIN MANAGEMENT OF TULSA P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:C
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-447-9300
Mailing Address - Street 1:6802 S OLYMPIA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-1823
Mailing Address - Country:US
Mailing Address - Phone:918-447-9300
Mailing Address - Fax:918-447-9308
Practice Address - Street 1:6802 S OLYMPIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-1823
Practice Address - Country:US
Practice Address - Phone:918-447-9300
Practice Address - Fax:918-447-9308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2940207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKDF6291OtherRAILROAD MEDICARE
OK200107040AMedicaid
OK=========001OtherBCBS GROUP ID
OK900522562Medicare PIN