Provider Demographics
NPI:1871729723
Name:PROFESSIONAL PHYSICIAN PAIN SERVICES, LLC
Entity type:Organization
Organization Name:PROFESSIONAL PHYSICIAN PAIN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-947-5557
Mailing Address - Street 1:4400 WILL ROGERS PKWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-1837
Mailing Address - Country:US
Mailing Address - Phone:405-947-5557
Mailing Address - Fax:405-948-6507
Practice Address - Street 1:114 PIPER HILL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1661
Practice Address - Country:US
Practice Address - Phone:636-442-5035
Practice Address - Fax:636-442-5036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004009978207LP2900X
MO2006018031207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty