Basic Information
| Provider Information | |||||||||
| NPI: | 1427375047 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PARKER ROAD INTERVENTIONAL PAIN PROCEDURE CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 268945 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731268945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724791115 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17051 DALLAS PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750017101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4699160521 | ||||||||
| FaxNumber: | 9722340212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2010 | ||||||||
| LastUpdateDate: | 10/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | WALLS | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9722344740 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP3300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Pain |
No ID Information.