1477087393 NPI number — PREFERRED PAIN ASSOCIATES OF ALABAMA, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477087393 NPI number — PREFERRED PAIN ASSOCIATES OF ALABAMA, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED PAIN ASSOCIATES OF ALABAMA, PC
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:
PREFERRED PAIN ASSOCIATES OF ALABAMA
Provider Other Organization Name Type Code:
3
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:
1477087393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5057 PINNACLE SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35235-3216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-508-5300
Provider Business Mailing Address Fax Number:
205-508-5552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5057 PINNACLE SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35235-3216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-508-5300
Provider Business Practice Location Address Fax Number:
205-508-5552
Provider Enumeration Date:
04/18/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FRENETTE
Authorized Official First Name:
LUC
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-508-2300

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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