Healthcare Provider Details

I. General information

NPI: 1548239494
Provider Name (Legal Business Name): NEUROSCIENCE SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 PARKWAY COMMONS DR STE 100
OKLAHOMA CITY OK
73134-6036
US

IV. Provider business mailing address

14100 PARKWAY COMMONS DR STE 100
OKLAHOMA CITY OK
73134-6036
US

V. Phone/Fax

Practice location:
  • Phone: 405-748-3300
  • Fax: 405-749-1671
Mailing address:
  • Phone: 405-748-3300
  • Fax: 405-749-1671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. NICHOLAS MCCOLLUM
Title or Position: DIRECTOR OF TECHNOLOGY
Credential:
Phone: 405-748-3300