Healthcare Provider Details

I. General information

NPI: 1376862771
Provider Name (Legal Business Name): OKLAHOMA PAIN AND WELLNESS CENTER, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 07/21/2022
Certification Date:
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 Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAYEN H PATEL
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 918-935-3240