Healthcare Provider Details

I. General information

NPI: 1922330927
Provider Name (Legal Business Name): ALTERNATIVE PAIN CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 S HARVARD AVE SUITE 308
TULSA OK
74114-3300
US

IV. Provider business mailing address

2325 S HARVARD AVE SUITE 308
TULSA OK
74114-3300
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-5959
  • Fax: 918-742-4412
Mailing address:
  • Phone: 918-744-5959
  • Fax: 918-742-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15263
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number15236
License Number StateOK

VIII. Authorized Official

Name: DR. SHIRLEY J WELDEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 918-744-5959