MR. THOMAS A MAIBENCO (NPI# 1639211386) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639211386 |
| Entity Type | Individual |
| Full Name | MR. THOMAS A MAIBENCO |
| Credential | MD |
| Practice Address |
1500 E Downing St Ste 101 Tahlequah OK 74464-3354 |
| Mailing Address |
916 Talon Drive Suite 102 Ofallon IL 62269-1848 |
| Practice Telephone | 9184531234 |
| Mailing Telephone | 6186288211 |
| Mailing Fax Number | 6186280883 |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-03-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
35295 | OK | Allopathic & Osteopathic Physicians |
| N | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
336078668 | IL | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 916 Talon Drive, Suite 102, Ofallon, IL 622691848 | 6186288211 | 6186280883 |
| Street Address |
1500 E DOWNING ST STE 101 |
| City | TAHLEQUAH |
| State | OK |
| Zip Code | 74464-3354 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356791891 | Sandi Lynn Casey | Nurse Practitioner | 1500 E Downing St Ste 101, Tahlequah, OK 74464-3354 | 2016-06-15 |
| 1740544428 | Muneeza Afif | Internal Medicine | 1500 E Downing St Ste 101, Tahlequah, OK 74464-3354 | 2012-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184253403 | Kendall Harris | Student in an Organized Health Care Education/Training Program | 100 Bliss Ave, Tahlequah, OK 74464 | 2020-04-07 |
| 1528609302 | Norma Brightly | Technician | 103 Sequoyah, Tahlequah, OK 74464 | 2019-10-03 |
| 1073175832 | Jody Lynn Dallis | Case Manager/Care Coordinator | Tenkiller Behavioral Services, 27753 S. Welling Rd, Welling, OK 74464 | 2019-07-02 |
| 1184287849 | Perry Jake Proctor | Student in an Organized Health Care Education/Training Program | 1400 E Downing St, Tahlequah, Ok 74464, Tahlequah, OK 74464 | 2019-04-18 |
| 1336657279 | Sidney Sheyenne Kimble | Case Manager/Care Coordinator | 1429 Jack Brown Lane, Tahlequah, OK 74464 | 2018-01-12 |
| 1891225686 | Nichols Bradley Alberty | Orthotist | 1294 East Downing, Suite 3, Tahlequah, OK 74464 | 2017-06-14 |
| 1922549690 | Krystal Easter Ms, Lpc | Counselor | 2201 Oakridge Dr, Tahlequah, OK 74464 | 2017-03-15 |
| 1144777319 | Northeastern Oklahoma Community Health Centers, Inc. | Clinic/Center | 529 N. Oak St., Tahlequah, OK 74464 | 2016-09-06 |
| 1548713456 | Clement Isioma Nwadozi | Optometrist | 3763 Southridge Cir Apt 6, Tahlequah, OK 74464 | 2016-07-27 |
| 1033532635 | Wesley Gragg | Specialist/Technologist | 603 North Grand Avenue, Tahlequah, OK 74464 | 2014-02-03 |
| Find all providers in zip 74464 | ||||
| Taxonomy Code | 2081P2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Pain Medicine |
| A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Proposal under development. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700487147 | Zackery R Devine | Physical Medicine & Rehabilitation | 1029 Ne 6th St Apt 331, Oklahoma City, OK 73117-1459 | 2020-11-03 |
| 1447878269 | Tulsa Accident Care Center LLC | Physical Medicine & Rehabilitation | 5711 E 71st St Ste 100c, Tulsa, OK 74136-6655 | 2020-07-08 |
| 1265833842 | Rita Hancock Md Pllc | Physical Medicine & Rehabilitation | 1020 24th Ave Nw Ste 100, Norman, OK 73069-6341 | 2014-09-15 |
| 1275959686 | Advanced Strategies In Medical Management | Physical Medicine & Rehabilitation | 1132 N Broadway Dr, Oklahoma City, OK 73103-4910 | 2014-03-10 |
| 1073869715 | Rui Zhang | Physical Medicine & Rehabilitation | 620 S Madison St Ste 105, Enid, OK 73701-7270 | 2012-07-31 |
| 1437371952 | Pbghezzi,pllc | Physical Medicine & Rehabilitation | 310 Nw 21st Street, Oklahoma City, OK 73103 | 2007-05-03 |
| 1003036518 | Back & Posture Clinic of Oklahoma | Physical Medicine & Rehabilitation | 6510 S Western Ave Ste 100, Oklahoma City, OK 73139-1712 | 2007-04-26 |
| 1003981135 | Anil Kumar Reddy | Physical Medicine & Rehabilitation | 9725 East 79th Street, Suit A, Tulsa, OK 74133-4569 | 2006-11-22 |
| 1326148123 | Jeffrey S Halsell Do Pllc | Physical Medicine & Rehabilitation | 9308 S Toledo Ave, Tulsa, OK 74137-2739 | 2006-09-22 |
| 1811907538 | Omega Practice Management Inc | Physical Medicine & Rehabilitation | 1145 S. Utica, Ste 901, Tulsa, OK 74104-4013 | 2006-08-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.