Provider Demographics
NPI:1669663175
Name:ADDICTION RECOVERY MEDICAL SERVICES - PROVIDERS
Entity type:Organization
Organization Name:ADDICTION RECOVERY MEDICAL SERVICES - PROVIDERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD, MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:PAXTON
Authorized Official - Last Name:KEARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-880-5221
Mailing Address - Street 1:PO BOX 1545
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687
Mailing Address - Country:US
Mailing Address - Phone:704-880-4612
Mailing Address - Fax:704-818-1115
Practice Address - Street 1:536 SIGNAL HILL DR EXT
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625
Practice Address - Country:US
Practice Address - Phone:704-872-0234
Practice Address - Fax:704-818-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300179207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty