| NPI | 1790283752 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN PITTS Medical Director 918-208-7497 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OK 3982) |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain (Licence: OK 3982) |
| 207QA0401X Family Medicine, Addiction Medicine | |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2018-01-24 |