Healthcare Provider Details

I. General information

NPI: 1043835309
Provider Name (Legal Business Name): SEVA PAIN AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2020
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 E 15TH ST STE 102
TULSA OK
74104-5242
US

IV. Provider business mailing address

2811 E 15TH ST STE 102
TULSA OK
74104-5242
US

V. Phone/Fax

Practice location:
  • Phone: 918-935-3240
  • Fax: 918-935-3241
Mailing address:
  • Phone: 918-935-3240
  • Fax: 918-935-3241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAYEN H PATEL
Title or Position: MEMBER
Credential: MD
Phone: 918-935-3240