Provider Demographics
NPI:1407322605
Name:DR Q PAIN & SPINE CLINIC, PA
Entity Type:Organization
Organization Name:DR Q PAIN & SPINE CLINIC, PA
Other - Org Name:ASAP FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:IFTIKHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:501-227-0184
Mailing Address - Street 1:5700 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3328
Mailing Address - Country:US
Mailing Address - Phone:501-227-0184
Mailing Address - Fax:
Practice Address - Street 1:3901 MCCAIN PARK DR STE 102
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7849
Practice Address - Country:US
Practice Address - Phone:501-227-0184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR Q PAIN & SPINE CLINIC, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-16
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty