Healthcare Provider Details

I. General information

NPI: 1013702539
Provider Name (Legal Business Name): WESTERN OKLAHOMA PAIN SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SW 80TH ST
OKLAHOMA CITY OK
73139-8124
US

IV. Provider business mailing address

PO BOX 659506
SAN ANTONIO TX
78265-9506
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-4227
  • Fax: 405-601-4237
Mailing address:
  • Phone: 580-339-8001
  • Fax: 580-339-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN E BLICK
Title or Position: OWNER
Credential: DO
Phone: 580-339-8001