Provider Demographics
NPI:1225096613
Name:PAIN MANAGEMENT CTR MERIDIAN
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CTR MERIDIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AZHAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:PASHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-703-5600
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:WEARE
Mailing Address - State:NH
Mailing Address - Zip Code:03281-0228
Mailing Address - Country:US
Mailing Address - Phone:601-681-4985
Mailing Address - Fax:603-529-5981
Practice Address - Street 1:1102 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4001
Practice Address - Country:US
Practice Address - Phone:601-703-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07054364Medicaid
MS07054364Medicaid