MEDICARE: ENID PAIN AND SPINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	APA2056	OK

General Provider Information

NPI Number	:	1649540121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENID PAIN AND SPINE

Provider Business Mailing Address
First Line	:	DEPT 960356
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73196-0001
Country	:	US
Telephone Number	:	580-234-7246
Fax Number	:	580-233-2223

Provider Business Practice Location Address
First Line	:	427 E CHEROKEE AVE
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73701-5823
Country	:	US
Telephone Number	:	580-234-7246
Fax Number	:	580-233-2223

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	MICHAEL CHAD OWENS
Credential	:	D.O.
Telephone Number	:	580-234-7246

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	12/30/2011

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Directions to “ENID PAIN AND SPINE ” Practice Location

Language	Start Address	Practice Location

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