=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235252115
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OKLAHOMA CITY PAIN MANAGEMENT PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4205 MCAULEY BLVD SUITE 470
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73120-9391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-608-0823
-----------------------------------------------------
Fax | 405-608-0824
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4205 MCAULEY BLVD SUITE 470
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73120-9391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-608-0823
-----------------------------------------------------
Fax | 405-608-0824
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PUSHPA NAMBI JOSEPH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 405-608-0823
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number | 24655
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 24655
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------