Provider Demographics
NPI:1518303593
Name:INTEGRATED PAIN MANAGEMENT OF ALABAMA LLC
Entity Type:Organization
Organization Name:INTEGRATED PAIN MANAGEMENT OF ALABAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MANCHIKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-584-8842
Mailing Address - Street 1:PO BOX 8159
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36689-0159
Mailing Address - Country:US
Mailing Address - Phone:251-414-5810
Mailing Address - Fax:251-414-5809
Practice Address - Street 1:7860 COTTAGE HILL RD
Practice Address - Street 2:STE A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4102
Practice Address - Country:US
Practice Address - Phone:606-584-8842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty