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NPI Code Detail

MEDICARE: SPINECARE, INC.

MEDICARE: SPINECARE, INC.
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
1174400000XSpecialist15355OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1447649809003OTHEROKBLUE CROSS BLUE SHIELD ID

General Provider Information

NPI Number : 1942212360
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPINECARE, INC.
Provider Business Mailing Address
First Line : PO BOX 114
Second Line :
City : NORMAN
State : OK
Zip : 73070-0114
Country : US
Telephone Number : 405-329-2390
Fax Number : 405-329-0486
Provider Business Practice Location Address
First Line : 14101 PARKWAY COMMONS DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-6012
Country : US
Telephone Number : 405-749-2766
Fax Number : 405-749-6203
Authorized Official
Title or Position : ACCOUNT COORDINATOR
Name : MRS. PENNY VAUGHN
Credential :
Telephone Number : 405-329-2390
Provider Enumeration Date : 08/13/2006
Last Update Date : 08/22/2020

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Directions to “SPINECARE, INC. ” Practice Location

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