Healthcare Provider Details

I. General information

NPI: 1568701332
Provider Name (Legal Business Name): OSH PAIN MANAGEMENT ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 PARKWAY COMMONS DR STE 201
OKLAHOMA CITY OK
73134-6104
US

IV. Provider business mailing address

14100 PARKWAY COMMONS DR STE 201
OKLAHOMA CITY OK
73134-6104
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-2765
  • Fax:
Mailing address:
  • Phone: 405-749-2765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number15252
License Number StateOK

VIII. Authorized Official

Name: DR. KEVIN BLAYLOCK
Title or Position: CEO
Credential:
Phone: 405-990-0564