Provider Demographics
NPI:1871772004
Name:INSTITUTE OF PAIN MANAGEMENT, P.C.
Entity type:Organization
Organization Name:INSTITUTE OF PAIN MANAGEMENT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O. / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIEM
Authorized Official - Middle Name:
Authorized Official - Last Name:TRANG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-524-5200
Mailing Address - Street 1:3328 N CLASSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-3428
Mailing Address - Country:US
Mailing Address - Phone:405-524-5200
Mailing Address - Fax:
Practice Address - Street 1:3328 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-3428
Practice Address - Country:US
Practice Address - Phone:405-524-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3429207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100125970BMedicaid
OK100125970BMedicaid