Cherry Street Pain Clinic LLC
Clinic/Center, Pain in Tulsa, OK. Organization (NPI-2).
NPI number1124628656
StatusActive
Last updated in NPPESOct 26, 2020
Details
- NPI
- 1124628656
- Entity type
- Organization (NPI-2)
- Legal business name
- Cherry Street Pain Clinic LLC
- Organization subpart
- No
- Enumeration date
- Oct 26, 2020
- Certification date
- Oct 26, 2020
- Last updated
- Oct 26, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP3300X | Clinic/Center, Pain | – | – | Yes |
Practice location
1810 E 15th St Ste BTulsa, OK 74104-4611
Phone 918-836-6454
Mailing address
1810 E 15th St Ste BTulsa, OK 74104-4611
Phone 918-836-6454
Authorized official
Vernon Curtis Smith
Owner
9188366454
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