Provider Demographics
NPI:1194138412
Name:ADVANCE INVASIVE PAIN MANAGEMENT OF TULSA
Entity type:Organization
Organization Name:ADVANCE INVASIVE PAIN MANAGEMENT OF TULSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-744-1001
Mailing Address - Street 1:5018 E 68TH ST
Mailing Address - Street 2:200
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3367
Mailing Address - Country:US
Mailing Address - Phone:918-925-9905
Mailing Address - Fax:918-744-9729
Practice Address - Street 1:5018 E 68TH ST
Practice Address - Street 2:200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3367
Practice Address - Country:US
Practice Address - Phone:918-925-9905
Practice Address - Fax:918-744-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14910208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty