Provider Demographics
NPI:1871985788
Name:PAIN MANAGEMENT RESOURCES INC
Entity type:Organization
Organization Name:PAIN MANAGEMENT RESOURCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:ABOU-CHAKRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-285-8506
Mailing Address - Street 1:PO BOX 30233
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-0004
Mailing Address - Country:US
Mailing Address - Phone:405-285-8506
Mailing Address - Fax:888-680-6040
Practice Address - Street 1:2600 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3207
Practice Address - Country:US
Practice Address - Phone:405-285-8506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083590208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH448300OtherGROUP MEDICARE
OH0019551Medicaid