Provider Demographics
NPI:1992739908
Name:COMPREHENSIVE PAIN CENTER, INC.
Entity type:Organization
Organization Name:COMPREHENSIVE PAIN CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTORS OF OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-601-4227
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-0357
Mailing Address - Country:US
Mailing Address - Phone:405-775-9350
Mailing Address - Fax:405-775-9060
Practice Address - Street 1:301 SW 80TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-8124
Practice Address - Country:US
Practice Address - Phone:405-601-4227
Practice Address - Fax:405-601-4237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2427208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK050020190OtherMEDICARE RR
OK352470400OtherDOL
OK100742950AMedicaid
OK100742950AMedicaid
OK100742950AMedicaid
OK=========001OtherBC/BS
OK6771110001Medicare NSC