Provider Demographics
NPI:1972090991
Name:HANNAHAN COMPREHENSIVE PAIN CARE PC
Entity Type:Organization
Organization Name:HANNAHAN COMPREHENSIVE PAIN CARE PC
Other - Org Name:ROBERT HANNAHAN INTERVENTIONAL SPINE SPECIALIST
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:HANNAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-417-0450
Mailing Address - Street 1:PO BOX 1747
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-1747
Mailing Address - Country:US
Mailing Address - Phone:334-417-0450
Mailing Address - Fax:801-315-4946
Practice Address - Street 1:1275 JAMES DR STE B
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330
Practice Address - Country:US
Practice Address - Phone:251-599-6445
Practice Address - Fax:801-315-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20671207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000060068Medicaid