| NPI | 1003589706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE MAC GERMANY Physician Assistant CEO 405-504-5433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QP3300X Clinic/Center Pain | |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2021-08-05 |