Healthcare Provider Details

I. General information

NPI: 1235252115
Provider Name (Legal Business Name): OKLAHOMA CITY PAIN MANAGEMENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 MCAULEY BLVD SUITE 470
OKLAHOMA CITY OK
73120-9391
US

IV. Provider business mailing address

4205 MCAULEY BLVD SUITE 470
OKLAHOMA CITY OK
73120-9391
US

V. Phone/Fax

Practice location:
  • Phone: 405-608-0823
  • Fax: 405-608-0824
Mailing address:
  • Phone: 405-608-0823
  • Fax: 405-608-0824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number24655
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number24655
License Number StateOK

VIII. Authorized Official

Name: DR. PUSHPA NAMBI JOSEPH
Title or Position: OWNER
Credential: M.D.
Phone: 405-608-0823