Provider Demographics
NPI:1073960431
Name:CAHABA PAIN AND SPINE CARE, LLC
Entity Type:Organization
Organization Name:CAHABA PAIN AND SPINE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:THOMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-208-9001
Mailing Address - Street 1:2010 PATTON CHAPEL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-5784
Mailing Address - Country:US
Mailing Address - Phone:205-208-9001
Mailing Address - Fax:205-208-0031
Practice Address - Street 1:2010 PATTON CHAPEL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-5782
Practice Address - Country:US
Practice Address - Phone:205-208-9001
Practice Address - Fax:205-208-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27941207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL191618Medicaid
7557610001Medicare NSC
102G709329Medicare PIN