Provider Demographics
NPI:1528572443
Name:DR Q PAIN & SPINE CLINIC, PA
Entity Type:Organization
Organization Name:DR Q PAIN & SPINE CLINIC, PA
Other - Org Name:ARKANSAS SPINE AND PAIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
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:501-251-1975
Practice Address - Street 1:202 FRANKIE LN
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-2699
Practice Address - Country:US
Practice Address - Phone:501-227-0184
Practice Address - Fax:501-251-1975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. Q PAIN & SPINE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR179747002Medicaid