Healthcare Provider Details

I. General information

NPI: 1932014412
Provider Name (Legal Business Name): OKLAHOMA INTERVENTIONAL PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 E CENTRAL BLVD
ANADARKO OK
73005-4405
US

IV. Provider business mailing address

1002 E CENTRAL BLVD
ANADARKO OK
73005-4405
US

V. Phone/Fax

Practice location:
  • Phone: 405-247-2551
  • Fax:
Mailing address:
  • Phone: 405-247-2551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NICHOLE ANDERSON
Title or Position: OWNER
Credential:
Phone: 405-885-2084