Provider Demographics
NPI:1568716207
Name:CENTRAL ALABAMA PAIN MANAGEMENT CENTER, P.C.
Entity Type:Organization
Organization Name:CENTRAL ALABAMA PAIN MANAGEMENT CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:WILLIAMS
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-264-3367
Mailing Address - Street 1:1709 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1543
Mailing Address - Country:US
Mailing Address - Phone:334-264-3367
Mailing Address - Fax:334-264-3305
Practice Address - Street 1:1709 FOREST AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1543
Practice Address - Country:US
Practice Address - Phone:334-264-3367
Practice Address - Fax:334-264-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL157521835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000086173OtherMEDICARE ID
AL000086173OtherMEDICARE ID
AL6483340001Medicare NSC