Provider Demographics
NPI:1992815104
Name:BARRETT SPINAL CARE P C
Entity type:Organization
Organization Name:BARRETT SPINAL CARE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-453-0112
Mailing Address - Street 1:PO BOX 1778
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1778
Mailing Address - Country:US
Mailing Address - Phone:918-453-0112
Mailing Address - Fax:
Practice Address - Street 1:441 S MUSKOGEE AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4427
Practice Address - Country:US
Practice Address - Phone:918-453-0112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3664261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK515863800001OtherBLUE CROSS BLUE SHIELD OK
OKU96827Medicare UPIN