Oklahoma Spine Hospital LLC
Organization Active NPI General Acute Care Hospital · Oklahoma City, OK
NPI 1699745893 · NPPES record last updated Apr 27, 2026
Key facts
- NPI
- 1699745893
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 2345 (OK)
- Legal business name
- OKLAHOMA SPINE HOSPITAL LLC
- Practice address
- 14101 Parkway Commons Dr
Oklahoma City, OK 73134-6012 - Phone
- (405) 749-2700
- Fax
- (405) 749-2743
- NPI assigned
- Jan 23, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Kevin Lane Blaylock
- Title
- C.E.O
- Phone
- (405) 749-2700
Owners & managing parties with NPI records 13
-
Jacob Archer, M.D.
-
Fadi F Nasr, MD
-
James Michael Odor, M.D.
-
Nathan Overbey, MD
-
Brian Snell, MD
-
Robert E Tibbs Jr., M.D.
-
Benjamin T White, MD
-
Robert Jerome Wienecke, M.D.
-
Cooper Yates, MD
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 1
Member of 1
Member organizations 1
Facilities with the same owner 2
Practitioners 12
-
Dana S Cortez, P.A.-C
-
Jacob Archer, M.D.
-
Douglas P Beall, MD
-
Charles J Dunn, MD
-
Bradley Keith Lamprich, M.D.
-
Nathan Overbey, MD
-
Brian Snell, MD
-
Benjamin T White, MD
-
Cooper Yates, MD
Affiliated clinicians 105
-
Syed Hamza Ahmed, M.D.
-
Jacob Archer, M.D.
-
Douglas P Beall, MD
-
Brandi Bybee, APRN, CNP
-
Emily R. Coldiron, D.O.
-
Landon Coldiron, M.D.
-
Thomas E Cooke, MD
-
Dana S Cortez, P.A.-C
-
Charles Adam Cotton, M.D.
-
Dinesh Kumar Dalbir, M.D.
-
Oksana Didyuk, M.D.
-
John Tien Doan, MD
-
Robert Ethel, M.D., MBS
-
Jeffrey D. Floyd, M.D.
-
Bennett E Fuller, M.D.
Medicare Care Compare: Hospital
- Listed as
- Oklahoma Spine Hospital
- Type
- Acute Care Hospitals
- Ownership
- Physician
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OK
Hospital certification: CCN 370206
- Legal name
- OKLAHOMA SPINE HOSPITAL, L.L.C.
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Dec 14, 1999
- Last certification
- Jan 20, 2023
- Beds
- 25
- Ownership / control type
- Physician ownership
- Organization structure
- LLC · Proprietary
- Incorporated
- Feb 17, 1998 in OK
- Enrollment address
- 14101 Parkway Commons Dr
Oklahoma City, OK 73134-6012 - Hospital subgroups
- General
All disclosed owners & managing parties 22
| Name | Role | Since | Share |
|---|---|---|---|
| Fadi F Nasr |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 4.16% |
| Operational/Managerial Control |
Dec 31, 2024 | 4.16% | |
| Jacob B Archer |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 2.55% |
| Andrew B Parkinson |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 4.16% |
| Kevin L Blaylock |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 0.75% |
| Corporate Officer |
Dec 31, 2024 | 0.75% | |
| W-2 Managing Employee |
Dec 31, 2024 | 0.75% | |
| Nathan S Overbey |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 0.52% |
| Benjamin T White |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 2.4% |
| Robert E Tibbs |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 3.55% |
| Operational/Managerial Control |
Dec 31, 2024 | 3.55% | |
| Medical Facilities Corporation |
5% Or Greater Indirect Ownership Interest | Jun 21, 2005 | 63.96% |
| Medical Facilities America Inc |
5% Or Greater Indirect Ownership Interest | May 20, 2011 | 63.96% |
| Joseph Bridger Cox |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 4.16% |
| Operational/Managerial Control |
Dec 31, 2024 | 4.16% | |
| James Odor |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 4.16% |
| Operational/Managerial Control |
Dec 31, 2024 | 4.16% | |
| Osh Holdings II, LLC |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 12.88% |
| Brandon R Valantine |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 0.52% |
| Robert J Wienecke |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 3.85% |
| Operational/Managerial Control |
Dec 31, 2024 | 3.85% | |
| Osh Holdings, LLC |
5% Or Greater Direct Ownership Interest | Jun 21, 2005 | 36.04% |
| Medical Facilities America Holdco 2 LLC |
5% Or Greater Indirect Ownership Interest | Jul 23, 2019 | 63.96% |
| Christopher B White |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 0.58% |
| Medical Facilities America Holdco 1 LLC |
5% Or Greater Indirect Ownership Interest | Jul 23, 2019 | 63.96% |
| Brian E Snell |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 4.16% |
| Operational/Managerial Control |
Dec 31, 2024 | 4.16% | |
| Cooper Kye Alan Yates |
5% Or Greater Indirect Ownership Interest | Dec 31, 2024 | 0.52% |
| Medical Facilities USA Holdings Inc |
5% Or Greater Direct Ownership Interest | May 31, 2011 | 63.96% |
| Joann Parsley |
W-2 Managing Employee |
Sep 20, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080623000244 | OK | Part a Provider - Hospital | 3971674755 | Practice locations: Oklahoma City, OK |
| O20171024002964 | OK | Part B Supplier - Clinic/Group Practice | 5294001962 |
Receives reassigned benefits from 3 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Edmond, OK |
National Provider Directory
Locations
925 W I 35 Frontage Rd
Ste 100
Edmond, OK 73034
Phone (405) 306-2444
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 2345 | OK | Yes |
Addresses
Primary practice location
14101 Parkway Commons Dr
Oklahoma City, OK 73134-6012
Mailing address
PO Box 803918
Kansas City, MO 64180-3918
Phone (405) 775-4241
Other names
- Oklahoma Spine Hospital
- SSM Health Oklahoma Spine Hospital
NPI Registry JSON
{
"created_epoch": "1137974400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1777248000000",
"number": "1699745893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 803918",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641803918",
"telephone_number": "405-775-4241",
"fax_number": "405-841-9385"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14101 PARKWAY COMMONS DR",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731346012",
"telephone_number": "405-749-2700",
"fax_number": "405-749-2743"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OKLAHOMA SPINE HOSPITAL LLC",
"organizational_subpart": "NO",
"enumeration_date": "2006-01-23",
"last_updated": "2026-04-27",
"certification_date": "2026-04-27",
"status": "A",
"authorized_official_last_name": "BLAYLOCK",
"authorized_official_first_name": "KEVIN",
"authorized_official_middle_name": "LANE",
"authorized_official_title_or_position": "C.E.O",
"authorized_official_telephone_number": "405-749-2700",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "282N00000X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital",
"state": "OK",
"license": "2345",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Oklahoma Spine Hospital",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "SSM Health Oklahoma Spine Hospital",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Oklahoma City, OK
- Oklahoma Specialty Pharmacy,LLC
- Oklahoma Spine and Brace Inc.
- Oklahoma Spine and Musculoskeletal Medicine, PLLC
- Oklahoma Spine and Rehabilitation
- Oklahoma Spine Hospital LLC
- Oklahoma Spine Surgery & Orthopedics
- Oklahoma Spine Surgery Center
- Oklahoma Spine Surgery Center Physicians Group
- Oklahoma Sports & Spine Medicine,PLLC
- Oklahoma Sports and Orthopedics Institute PLLC
All providers in Oklahoma City, OK · General Acute Care Hospital in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.