Provider Demographics
NPI:1457727232
Name:SOUTH ALABAMA PAIN MANAGEMENT PLLC
Entity Type:Organization
Organization Name:SOUTH ALABAMA PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROOQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-517-1822
Mailing Address - Street 1:4325 MIDMOST DR STE A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-5545
Mailing Address - Country:US
Mailing Address - Phone:251-517-1822
Mailing Address - Fax:251-662-9482
Practice Address - Street 1:4325 MIDMOST DR STE A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-5545
Practice Address - Country:US
Practice Address - Phone:251-517-1822
Practice Address - Fax:251-662-9482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28820208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5101930494Medicare PIN
AL1025010064Medicare PIN