1649696097 NPI number — NATIONAL CENTERS FOR PAIN MANAGEMENT AND RESEARCH, LLC

Table of content: (NPI 1649696097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649696097 NPI number — NATIONAL CENTERS FOR PAIN MANAGEMENT AND RESEARCH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL CENTERS FOR PAIN MANAGEMENT AND RESEARCH, 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:
6
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:
1649696097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
860 MONTCLAIR RD
Provider Second Line Business Mailing Address:
SUITE 955
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35213-1923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-332-3160
Provider Business Mailing Address Fax Number:
866-702-0880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 S BRYANT AVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
EDMOND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73034-6399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-601-8810
Provider Business Practice Location Address Fax Number:
877-795-8060
Provider Enumeration Date:
03/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HOOD
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
205-868-3167

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  27258 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: 27258 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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