Medical Center Pain Clinic, PLLC

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

License

15874 Issued in OK

Legal business name

MEDICAL CENTER PAIN CLINIC, PLLC

Practice address

1226 N Shartel Ave
Suite 300
Oklahoma City, OK 73103

Phone

(405) 232-8003

Fax

(405) 232-8808

NPI assigned

Mar 22, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. David Paul Ellis, MD

Title

Registered Agent

Phone

(405) 232-8003

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amber M Drennen, PA-C

  • Physician Assistant
  • Oklahoma City, OK
  • NPI 1811294754
  NPD
• Melissa Sue Gibson, PA

  • Physician Assistant
  • Oklahoma City, OK
  • NPI 1326101700
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531526400000",
    "number": "1477829554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 NE 63RD ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731118305",
            "telephone_number": "405-271-5859",
            "fax_number": "405-232-8808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1226 N SHARTEL AVE",
            "address_2": "SUITE 300",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73103",
            "telephone_number": "405-232-8003",
            "fax_number": "405-232-8808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL CENTER PAIN CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-22",
        "last_updated": "2018-07-14",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "REGISTERED AGENT",
        "authorized_official_telephone_number": "405-232-8003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "OK",
            "license": "15874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200432890A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pain Clinic/Center in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Pain Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.