Healthcare Provider Details

I. General information

NPI: 1932240041
Provider Name (Legal Business Name): PAIN MANAGEMENT OF TULSA P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6802 S OLYMPIA AVE SUITE 100
TULSA OK
74132-1823
US

IV. Provider business mailing address

6802 S OLYMPIA AVE SUITE 100
TULSA OK
74132-1823
US

V. Phone/Fax

Practice location:
  • Phone: 918-447-9300
  • Fax: 918-447-9308
Mailing address:
  • Phone: 918-447-9300
  • Fax: 918-447-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number2940
License Number StateOK

VIII. Authorized Official

Name: DR. C SCOTT ANTHONY
Title or Position: OWNER
Credential: DO
Phone: 918-447-9300