1588710289 NPI number — THE CENTER FOR PAIN OF MONTGOMERY LLC

Table of content: (NPI 1588710289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588710289 NPI number — THE CENTER FOR PAIN OF MONTGOMERY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CENTER FOR PAIN OF MONTGOMERY LLC
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:
1588710289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 DEFENSE HWY STE 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-7096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-288-7808
Provider Business Mailing Address Fax Number:
334-387-3090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2065 E. S. BLVD.
Provider Second Line Business Practice Location Address:
STE. 401
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-288-7808
Provider Business Practice Location Address Fax Number:
334-387-3090
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KATZ
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
334-288-7808

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 529703000 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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