MEDICARE: OKLAHOMA PAIN INSTITUTE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	29617	OK

General Provider Information

NPI Number	:	1013353440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA PAIN INSTITUTE PLLC

Provider Business Mailing Address
First Line	:	PO BOX 108809
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73101-8809
Country	:	US
Telephone Number	:	405-775-9350
Fax Number	:	405-775-9360

Provider Business Practice Location Address
First Line	:	5460 MAIN ST STE 100
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-5525
Country	:	US
Telephone Number	:	405-733-5900
Fax Number	:	405-733-5905

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW J BOECKMAN
Credential	:	MD
Telephone Number	:	405-418-4500

Provider Enumeration Date	:	05/13/2013
Last Update Date	:	03/09/2026

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