Healthcare Provider Details

I. General information

NPI: 1821967100
Provider Name (Legal Business Name): OKLAHOMA INJURY MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 W AIRPORT FWY STE 210
IRVING TX
75062-5840
US

IV. Provider business mailing address

4441 W AIRPORT FWY STE 210
IRVING TX
75062-5840
US

V. Phone/Fax

Practice location:
  • Phone: 405-857-0779
  • Fax: 405-832-1118
Mailing address:
  • Phone: 405-857-0779
  • Fax: 405-832-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA MELISSA TARIN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 214-625-9018