Healthcare Provider Details

I. General information

NPI: 1013444298
Provider Name (Legal Business Name): ESSENTIAL INTEGRATIVE HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2017
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 NW 56TH ST SUITE 612
OKLAHOMA CITY OK
73112-4479
US

IV. Provider business mailing address

13924 QUAIL POINTE DR STE B
OKLAHOMA CITY OK
73134-1024
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-8810
  • Fax: 866-702-0880
Mailing address:
  • Phone: 405-601-8810
  • Fax: 405-601-8846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number27258
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number21476
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number27258
License Number StateOK

VIII. Authorized Official

Name: ARTHUR H CONLEY III
Title or Position: PHYSICIAN / OWNER
Credential: MD
Phone: 405-703-7300