Healthcare Provider Details

I. General information

NPI: 1104219385
Provider Name (Legal Business Name): AVENSTAR PAIN SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 S SOONER RD
MIDWEST CITY OK
73110
US

IV. Provider business mailing address

1732 S SOONER RD
MIDWEST CITY OK
73110
US

V. Phone/Fax

Practice location:
  • Phone: 405-438-0913
  • Fax:
Mailing address:
  • Phone: 405-438-0913
  • Fax: 405-438-0958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberN4691
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2493
License Number StateOK

VIII. Authorized Official

Name: STEVE ERIC RANDALL
Title or Position: OWNER
Credential: MD
Phone: 405-438-0913