NPIMap

Organization Active NPI

The Spine and Pain Center LLC

  • Pain Medicine (Anesthesiology) Physician
  • Tulsa, OK
National Provider Identifier
1689144602
Registry record updated Oct 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
THE SPINE AND PAIN CENTER LLC
Practice address
1919 S Wheeling Ave Ste 204
Tulsa, OK 74104-5631
Phone
(918) 727-7246
NPI assigned
Dec 3, 2018
Last updated
Oct 31, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2025

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

Authorized official

Name
Adam Wallace, MDNPI 1518129733
Title
Owner
Phone
(918) 727-7246

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X Primary

Addresses

Primary practice location

1919 S Wheeling Ave Ste 204
Tulsa, OK 74104-5631

Mailing address

1919 S Wheeling Ave Ste 204
Tulsa, OK 74104-5631

Other practice location 1

3336 E 32nd St Ste 220
Tulsa, OK 74135-4442
Phone (918) 255-7246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190109001617 OK Part B Supplier - Clinic/Group Practice 6002152220 Receives reassigned benefits from 9 practitioners
Practice locations: Bartlesville, OK; Muskogee, OK; Tulsa, OK

National Provider Directory

National Provider Directory

Locations

3019 Azalea Park Dr
Muskogee, OK 74401
Phone (918) 351-7246

1844 E 15th St
Tulsa, OK 74104
Phone (918) 727-7246

1919 S Wheeling Ave
Ste 204
Tulsa, OK 74104
Phone (918) 403-7200

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1543795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761868800000",
    "number": "1689144602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 S WHEELING AVE STE 204",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 S WHEELING AVE STE 204",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045631",
            "telephone_number": "918-727-7246"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3336 E 32nd St Ste 220",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741354442",
            "country_code": "US",
            "telephone_number": "918-255-7246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE SPINE AND PAIN CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-03",
        "last_updated": "2025-10-31",
        "certification_date": "2025-10-31",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-727-7246",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.