Healthcare Provider Details

I. General information

NPI: 1255941423
Provider Name (Legal Business Name): PROCEDURAL PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9906 RIVERSIDE PKWY
TULSA OK
74137-7409
US

IV. Provider business mailing address

9906 RIVERSIDE PKWY
TULSA OK
74137-7409
US

V. Phone/Fax

Practice location:
  • Phone: 918-298-8080
  • Fax:
Mailing address:
  • Phone: 918-298-8080
  • Fax:

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: DR. LADD CLAYTON ATKINS
Title or Position: OWNER
Credential: D.O.
Phone: 918-298-8080