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General NPI Number Information
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NPI Number | 1124139126
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Entity Type | Organization
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Legal Business Name | PAIN INSTITUTE OF TULSA, INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 06/25/2009
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Provider Practice Location Address
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Address Line | 1145 S UTICA AVE SUITE 364
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City | TULSA
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State | OK
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Zip | 74104-4004
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Country | US
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Telephone | 918-496-5195
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Fax | 918-496-5194
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Provider Business Mailing Address
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Address Line | 1145 S UTICA AVE SUITE 364
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City | TULSA
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State | OK
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Zip | 74104-4004
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Country | US
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Telephone | 918-496-5195
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Fax | 918-496-5194
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Authorized Official
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Title or Position | OWNER
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Name | RAYMOND F SORENSEN
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Credential | DO
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Telephone | 918-496-5195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1434
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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 | 1732
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License Number State | OK
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