Provider Demographics
NPI:1235329160
Name:WELLNESS PAIN & TREATMENT CENTER
Entity Type:Organization
Organization Name:WELLNESS PAIN & TREATMENT CENTER
Other - Org Name:WELLNESS TREATMENT CENTER PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAMPULLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-462-0969
Mailing Address - Street 1:535 JACK WARNER PKWY NE
Mailing Address - Street 2:SUITE G1
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-5751
Mailing Address - Country:US
Mailing Address - Phone:205-462-0969
Mailing Address - Fax:205-562-1936
Practice Address - Street 1:535 JACK WARNER PKWY NE
Practice Address - Street 2:SUITE G1
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5751
Practice Address - Country:US
Practice Address - Phone:205-462-0969
Practice Address - Fax:205-562-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00016409207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC89426Medicare UPIN