Healthcare Provider Details

I. General information

NPI: 1700235645
Provider Name (Legal Business Name): ELITE PAIN & HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 N WESTERN AVE STE 303
OKLAHOMA CITY OK
73114-1432
US

IV. Provider business mailing address

13100 N WESTERN AVE STE 303
OKLAHOMA CITY OK
73114-1432
US

V. Phone/Fax

Practice location:
  • Phone: 800-781-1220
  • Fax: 888-678-8616
Mailing address:
  • Phone: 800-781-1220
  • Fax: 888-678-8616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KELEY JOHN BOOTH
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 800-781-1220