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General NPI Number Information
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NPI Number | 1346131182
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL SPINE SERVICES- III
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 1907 N BROADWAY AVE STE B
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City | OKLAHOMA CITY
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State | OK
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Zip | 73103-4407
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Country | US
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Telephone | 405-702-7246
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Fax | 405-609-6679
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Provider Business Mailing Address
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Address Line | PO BOX 152
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City | OKLAHOMA CITY
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State | OK
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Zip | 73101-0152
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | EMILI GRAGG
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Credential |
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Telephone | 405-219-2651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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