Provider Demographics
NPI:1942212360
Name:SPINECARE, INC.
Entity type:Organization
Organization Name:SPINECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-329-2390
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-0114
Mailing Address - Country:US
Mailing Address - Phone:405-329-2390
Mailing Address - Fax:405-329-0486
Practice Address - Street 1:14101 PARKWAY COMMONS DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-6012
Practice Address - Country:US
Practice Address - Phone:405-749-2766
Practice Address - Fax:405-749-6203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15355174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK447649809003OtherBLUE CROSS BLUE SHIELD ID
OK447649809003OtherBLUE CROSS BLUE SHIELD ID