Healthcare Provider Details

I. General information

NPI: 1295053312
Provider Name (Legal Business Name): PAIN MANAGEMENT SOLUTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 SHADOWLAKE DR BUILDING O
OKLAHOMA CITY OK
73159-7441
US

IV. Provider business mailing address

PO BOX 268977
OKLAHOMA CITY OK
73126-8977
US

V. Phone/Fax

Practice location:
  • Phone: 405-378-0600
  • Fax:
Mailing address:
  • Phone: 405-378-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number22845
License Number StateOK

VIII. Authorized Official

Name: GEORGE S ALHAJ
Title or Position: MD
Credential:
Phone: 405-620-4900