Healthcare Provider Details

I. General information

NPI: 1699100164
Provider Name (Legal Business Name): THE BROOKS ACCIDENT AND INJURY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 NW 13TH ST
OKLAHOMA CITY OK
73106-6827
US

IV. Provider business mailing address

820 NW 13TH ST
OKLAHOMA CITY OK
73106-6827
US

V. Phone/Fax

Practice location:
  • Phone: 405-943-0303
  • Fax:
Mailing address:
  • Phone: 405-943-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2502
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number20823
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1432
License Number StateOK

VIII. Authorized Official

Name: RODNEY MILLER
Title or Position: OWNER
Credential:
Phone: 405-943-0303