Provider Demographics
NPI:1033692561
Name:PAIN TREATMENT CENTERS OF AMERICA, PLLC
Entity Type:Organization
Organization Name:PAIN TREATMENT CENTERS OF AMERICA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP/COO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEHK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-541-6889
Mailing Address - Street 1:108 N SHACKLEFORD RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2840
Mailing Address - Country:US
Mailing Address - Phone:501-712-2571
Mailing Address - Fax:501-404-7789
Practice Address - Street 1:118 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7328
Practice Address - Country:US
Practice Address - Phone:501-791-9767
Practice Address - Fax:888-630-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies