1225428261 NPI number — PAIN SPECIALISTS OF GADSDEN, INC

Table of content: EMILY ANNE HYMES OTR (NPI 1184273229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225428261 NPI number — PAIN SPECIALISTS OF GADSDEN, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN SPECIALISTS OF GADSDEN, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225428261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1026 GOODYEAR AVE
Provider Second Line Business Mailing Address:
BLD 400 SUITE 301
Provider Business Mailing Address City Name:
GADSDEN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35903-1102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-492-7246
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1026 GOODYEAR AVE
Provider Second Line Business Practice Location Address:
BLD 400 SUITE 301
Provider Business Practice Location Address City Name:
GADSDEN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35903-1102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-492-7246
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JACOBS-MURATTA
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
256-492-7246

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X , with the licence number:  3267 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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