Healthcare Provider Details

I. General information

NPI: 1992992507
Provider Name (Legal Business Name): SAFESPINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 S WESTERN AVE ROOM 108
OKLAHOMA CITY OK
73139-9200
US

IV. Provider business mailing address

8601 S WESTERN AVE ROOM 108
OKLAHOMA CITY OK
73139-9200
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-5979
  • Fax: 405-601-2826
Mailing address:
  • Phone: 405-601-5979
  • Fax: 405-601-2826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateOK

VIII. Authorized Official

Name: CHARLES DEWAYNE POOR
Title or Position: PRESIDENT
Credential: MBR
Phone: 405-601-5979