Provider Demographics
NPI:1356848014
Name:FLOWOOD PAIN CENTER, LLC
Entity Type:Organization
Organization Name:FLOWOOD PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:855-343-5763
Mailing Address - Street 1:PO BOX 722354
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-8783
Mailing Address - Country:US
Mailing Address - Phone:601-339-2065
Mailing Address - Fax:601-420-2356
Practice Address - Street 1:120 STONE CREEK BLVD STE 500
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8210
Practice Address - Country:US
Practice Address - Phone:601-420-2040
Practice Address - Fax:601-420-2356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207LP2900X
MS208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty