Provider Demographics
NPI:1306839196
Name:ABDUL NAUSHAD MD PC
Entity Type:Organization
Organization Name:ABDUL NAUSHAD MD PC
Other - Org Name:ADVANCED PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:N
Authorized Official - Last Name:NAUSHAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-638-1506
Mailing Address - Street 1:622 COLLINS DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2077
Mailing Address - Country:US
Mailing Address - Phone:636-638-1506
Mailing Address - Fax:636-638-1507
Practice Address - Street 1:2865 JAMES BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2803
Practice Address - Country:US
Practice Address - Phone:636-638-1506
Practice Address - Fax:636-638-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207LP2900X, 2081P2900X
208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1306839196Medicaid
MO197806OtherBLUE CROSS BLUE SHIELD
MO000000471330OtherBCBS
MO567896OtherHEALTHLINK
MO000013774Medicare PIN
MO197806OtherBLUE CROSS BLUE SHIELD
MO567896OtherHEALTHLINK
AR1584580002Medicaid
MOMA2027Medicare PIN