Healthcare Provider Details

I. General information

NPI: 1871303503
Provider Name (Legal Business Name): APEX PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 E WASHINGTON AVE
MCALESTER OK
74501-4850
US

IV. Provider business mailing address

1030 E WASHINGTON AVE
MCALESTER OK
74501-4850
US

V. Phone/Fax

Practice location:
  • Phone: 918-401-1002
  • Fax:
Mailing address:
  • Phone: 918-401-1002
  • Fax: 918-493-3304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TYESHA MOSQUITO
Title or Position: PHYSICIAN RELATIONS DIRECTOR
Credential:
Phone: 918-519-4090