Provider Demographics
NPI:1811928724
Name:PAIN MANAGEMENT CENTER OF NORTH
Entity type:Organization
Organization Name:PAIN MANAGEMENT CENTER OF NORTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:HAMMITT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:662-407-0801
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-1218
Mailing Address - Country:US
Mailing Address - Phone:800-897-6169
Mailing Address - Fax:800-897-6170
Practice Address - Street 1:2089 SOUTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6478
Practice Address - Country:US
Practice Address - Phone:662-407-0801
Practice Address - Fax:662-407-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSDC4899OtherRAILROAD MEDICARE
MS07277812Medicaid
MS07277812Medicaid