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General NPI Number Information
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NPI Number | 1306229422
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Entity Type | Organization
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Legal Business Name | MORGAN VANDERLICK QUALITY PAIN MANAGEMENT, LLC
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 1916 W C ST
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City | JENKS
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State | OK
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Zip | 74037-2367
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Country | US
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Telephone | 918-701-2055
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Fax | 918-701-2056
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Provider Business Mailing Address
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Address Line | 1916 W C ST
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City | JENKS
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State | OK
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Zip | 74037-2367
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Country | US
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Telephone | 918-701-2055
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Fax | 918-701-2056
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Authorized Official
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Title or Position | OWNER
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Name | KAREN J MORGAN-VANDERLICK
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Credential | M.D.
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Telephone | 918-701-2055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 25659
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License Number State | OK
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