Provider Demographics
NPI:1467866624
Name:PAIN TREATMENT CENTERS OF ALABAMA, PC
Entity Type:Organization
Organization Name:PAIN TREATMENT CENTERS OF ALABAMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-284-9600
Mailing Address - Street 1:470 TAYLOR RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3563
Mailing Address - Country:US
Mailing Address - Phone:334-284-9600
Mailing Address - Fax:334-396-6929
Practice Address - Street 1:470 TAYLOR RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3563
Practice Address - Country:US
Practice Address - Phone:334-284-9600
Practice Address - Fax:334-396-6929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty