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General NPI Number Information
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NPI Number | 1700209566
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Entity Type | Organization
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Legal Business Name | PRECISION PAIN MANAGEMENT OF OKLAHOMA
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 4110 S. 100TH E. AVE. STE 201
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City | TULSA
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State | OK
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Zip | 74146-6936
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Country | US
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Telephone | 918-857-7246
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Fax | 918-359-5828
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Provider Business Mailing Address
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Address Line | 4110 S 100TH E. AVE. STE. 74146
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City | TULSA
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State | OK
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Zip | 74136-3311
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Country | US
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Telephone | 918-857-7246
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Fax | 918-359-5828
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Authorized Official
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Title or Position | CONTRACTING SPECIALIST
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Name | LISA BRISCOE
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Credential |
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Telephone | 918-893-9445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State | OK
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