NPI 1104549427

Broken Arrow Pain Specialist, LLC

Organisation Pain Medicine Physician Tahlequah, OK

Practice location

Address: 2028 Mahaney Ave, Tahlequah, OK 74464-5783
Phone: (918) 992-6050
Fax: (833) 763-2349

Authorised official

Name: Ian Kelley
Title: Sole Member
Phone: (918) 633-0447

Registered specialties

Pain Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208VP0000X

Other Pain Medicine providers in Oklahoma →

Registry record

NPI: 1104549427
Entity type: Organization
NPI issued: 21 Sep 2022
Record last updated: 22 Jul 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.