Provider Demographics
NPI:1326546276
Name:HEADACHE & PAIN CENTER, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HEADACHE & PAIN CENTER, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:NOLAN
Authorized Official - Last Name:PONDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:985-580-1200
Mailing Address - Street 1:123 FRONTAGE ROAD A
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:LA
Mailing Address - Zip Code:70359-6301
Mailing Address - Country:US
Mailing Address - Phone:985-580-1200
Mailing Address - Fax:985-580-1218
Practice Address - Street 1:531A JEFFERSON TER
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4949
Practice Address - Country:US
Practice Address - Phone:337-560-0880
Practice Address - Fax:337-560-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies