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General NPI Number Information
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NPI Number | 1073600714
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Entity Type | Organization
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Legal Business Name | PAIN CARE ASSOCIATES OF OKLAHOMA
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 6585 S YALE AVE SUITE 1110
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City | TULSA
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State | OK
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Zip | 74136-8384
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Country | US
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Telephone | 918-502-7246
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Fax | 918-519-7250
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Provider Business Mailing Address
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Address Line | PO BOX 701683
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City | TULSA
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State | OK
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Zip | 74170-1683
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Country | US
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Telephone | 918-398-9683
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Fax | 918-398-9095
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN T LESTER
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Credential | MD
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Telephone | 918-502-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 538
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4609
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25659
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 16519
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License Number State | OK
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