Provider Demographics
NPI:1235381013
Name:BOLTZ PAIN CENTER, LLC
Entity Type:Organization
Organization Name:BOLTZ PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-626-9544
Mailing Address - Street 1:1 TIMBER WAY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-5682
Mailing Address - Country:US
Mailing Address - Phone:251-626-9544
Mailing Address - Fax:
Practice Address - Street 1:1 TIMBER WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-5682
Practice Address - Country:US
Practice Address - Phone:251-626-9544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-12
Last Update Date:2008-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.21886207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty