CHERRY STREET PAIN CLINIC LLC NPI 1124628656

NPI Information

CHERRY STREET PAIN CLINIC LLC is a pain clinic center in Tulsa, OK. CHERRY STREET PAIN CLINIC LLC NPI is 1124628656. The provider is registered as an organization entity type.

The provider's business location address is:

1810 E 15TH ST STE B
TULSA, OK
ZIP 74104-611
Phone: (918) 836-6454

The provider's authorized official is Vernon Curtis Smith .
The authorized official title is Owner and has the following contact phone number (918) 836-6454.

The CLIA number assigned to this NPI record is 37D0908892 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/26/2020 and was last updated on 10/26/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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