Healthcare Provider Details

I. General information

NPI: 1942212360
Provider Name (Legal Business Name): SPINECARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14101 PARKWAY COMMONS DR
OKLAHOMA CITY OK
73134-6012
US

IV. Provider business mailing address

PO BOX 114
NORMAN OK
73070-0114
US

V. Phone/Fax

Practice location:
  • Phone: 405-749-2766
  • Fax: 405-749-6203
Mailing address:
  • Phone: 405-329-2390
  • Fax: 405-329-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number15355
License Number StateOK

VIII. Authorized Official

Name: MRS. PENNY VAUGHN
Title or Position: ACCOUNT COORDINATOR
Credential:
Phone: 405-329-2390