Healthcare Provider Details

I. General information

NPI: 1033922034
Provider Name (Legal Business Name): OKC CAR CRASH CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 S KLEIN AVE STE 900
OKLAHOMA CITY OK
73109-3839
US

IV. Provider business mailing address

4525 S KLEIN AVE STE 900
OKLAHOMA CITY OK
73109-3839
US

V. Phone/Fax

Practice location:
  • Phone: 405-862-7274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTIN LOPEZ
Title or Position: OWNER
Credential: MD
Phone: 405-862-7274