Healthcare Provider Details

I. General information

NPI: 1982253811
Provider Name (Legal Business Name): ULTIMATE HEALTH AND PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 EAST 15TH STREET
TULSA OK
74104
US

IV. Provider business mailing address

8177 S HARVARD AVE # 724
TULSA OK
74137-1612
US

V. Phone/Fax

Practice location:
  • Phone: 918-504-4182
  • Fax:
Mailing address:
  • Phone:
  • 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: DREW LAWRENCE
Title or Position: CHIROPRACTOR
Credential:
Phone: 918-504-4182